Is Cooling the solution?

It is still not clear if we should cool our patients after a cardiac arrest or a trauma brain injury, but you should decide after these conclusions:

I like this study in children (1) which shows in comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a good functional outcome.

In children with severe traumatic brain injury, hypothermia therapy that is initiated within 8 hours after injury and continued for 24 hours does not improve the neurologic outcome and may increase mortality (2).

And if this is happening in children, in adults is not going to be better:

In a recent publication in the NEJM is shown that hypothermia can successfully reduce brain pressure following trauma, but after 6 months functional recovery was significantly worse than standard care alone.

We know that targeting a temperature of 36°C had similar outcomes to cooling patients to 33°C, so by now, irrespective of whether therapeutic hypothermia or targeted temperature management is deployed in patients at risk of hypoxic brain injury, it would seem that the most important measure is to avoid hyperpyrexia.

(1) Moler, F. W., Silverstein, F. S., Holubkov, R., Slomine, B. S., Christensen, J. R., Nadkarni, V. M., . . . Dean, J. M. (2015). Therapeutic hypothermia after out-of-hospital cardiac arrest in children. The New England Journal of Medicine, 372(20), 1898-1908. Retrieved from http://search.proquest.com/docview/1680992803?accountid=48421.

(2) Hutchison, J. S., M.D., Ward, R. E., B.A., Lacroix, J., M.D., Hébert, Paul C, MD, MHSc, Barnes, M. A., PhD., Bohn, D. J., M.B., . . . Skippen, P. W., M.D. (2008). Hypothermia therapy after traumatic brain injury in children. The New England Journal of Medicine, 358(23), 2447-56. doi:http://dx.doi.org/10.1056/NEJMoa0706930.

(3)