“The American Academy of Neurology Affirms the Revival of Cooling for the Revived”

This is the “sexy” title of an editorial in the May 31, 2017 Neurology journal issue. Authors, Drs. Kapinos and Becker, praise the authors of the AAN practice guideline for acute interventions to reduce brain injury in comatose adults after cardiac arrest with ROSC (published in the same issue, Epub May 10). They congratulated the guideline authors “We concur with the AAN experts that less is not more and cooling should be harder, better, faster, stronger, [sic]”.

The authors of the guideline reviewed the 4 major class I trials assessing response to therapeutic hypothermia (TH), target temperature 32-34°C, in cardiac arrest patients with shockable rhythm (ventricular tachycardia or ventricular fibrillation).

Three studies compared TH to non-TH and concluded that TH resulted in significant improvement of neurologic outcome. One study by Nielsen et al. compared TH to targeted temperature management (TTM) and failed to find a significant superiority of either method. Given the available evidence, the guideline gave level A evidence for TH in shockable rhythm out-of-hospital cardiac arrest and level B for TTM. The article addressed the need for further research to identify the optimal temperature settings, duration of treatment and optimal window of treatment.

Did the editorial address the contents of the guidelines objectively?

As a non-expert in the field, I am asking the Neurocritical care colleagues for their input. Is there any possible role of the reported disclosures in the affirmative language of the editorial compared to the more nuanced guideline?