Thread by @Gas_Craic

Prof. Jerry Nolan - a giant of resuscitation - discusses why we can't replicate the trial outcomes in cooling post-cardiac arrest.... #SOA21 A thread 🧵👇

Jerry Nolan presenting! We know for sure that hypothermia BEFORE something like cardiac surgery is protective. As well as pre-cooling prior to cardiac arrest! #SOA21

Many animal studies. Mimic the clinical conditions of cardiac arrest. #SOA21 The timings here are important - mean no (asystole) /low-flow (CPR) times. Hypothermia induction times immediate OR delayed up to 60mins. Hypothermia improved neuro outcome and reduced mortality by 67%.

How do we move on from these studies? These ones (below) were unblinded, which was quite a problem. #SOA21

Mortality/Neuro outcome no different.... #SOA21

Is fever harmful after cardiac arrest? Maybe. No huge evidence base for this. #SOA21

One of few RCT's recently to show benefit for hypothermia... just one patient would have changed this study though... (Frag index, if you believe in it) #SOA21

And so this all led on to TTM2... not significantly different. #SOA21 ... leading to a barrage of discussion points from around the world.... saying TTM2 etc do not represent "our sorts of" cardiac arrest patients.

Bystander CPR, Time to cooling, ICU patients(not register patients), non-standardised post-arrest care - SO MANY variables.... #SOA21

Is the key to understanding why we can't replicate, the time to target temp? FIVE HOURS??? in most studies. ?Too long? #SOA21

Giving cold IV fluid intra-arrest though may be harmful.... so... #SOA21

Intranasal cooling!!! #SOA21 ~700 patients. Could data show trend towards being quicker in transnasal group? Faster temp reduction?

So: this is a bioplausible phenomenon, but this hasn't been born out in clinical trials (yet?). No high-certainty evidence that fever control results in better outcomes.... that will be looked at closer in TTM3 (which has just got funding...) #SOA21