• David F Gaieski, Barry Fuchs, Brendan G Carr, Raina Merchant, Daniel M Kolansky, Benjamin S Abella, Lance B Becker, Cheryl Maguire, Michael Whitehawk, Joshua Levine, and Munish Goyal.
• Department of Emergency Medicine, Hospital of the University of Pennsylvania, Ground Ravdin, Philadelphia, PA19104, USA. gaieskid@uphs.upenn.edu
• Hosp Pract (1995). 2009 Dec 1;37(1):71-83.

IntroductionSurvival after out-of-hospital cardiac arrest (OHCA) remains unacceptably low. Therapeutic hypothermia (TH) is the most efficacious treatment option available for comatose survivors of cardiac arrest. However, clearly delineated instructions for how to induce, maintain, and conclude TH have not been published in a codified format.ObjectiveWe assembled 11 clinicians from the University of Pennsylvania Schools of Medicine and Nursing for a day-long moderated discussion to review our institution's TH protocol and reach consensus on a step-by-step management plan of the comatose survivor of OHCA. We attempted to systematically work our way through the existing University of Pennsylvania TH protocol. The goal was to address critical decisions at each stage of care of the post-arrest patient, including whom to cool, how to cool, how long to cool, how to rewarm, neuroprognostication, and other fundamental aspects of patient management. We made every effort to include relevant scientific evidence with appropriate citations. However, given the paucity of data in certain areas, we have relied heavily on expert opinion.SummaryWe present a step-by-step management plan for incorporation of TH in the care of the comatose survivor of OHCA, which can be adapted to a variety of clinical settings with diverse resources. This article is intended to supplement current care provided by health care providers and should be adopted in concert with current standards of post-arrest and intensive care unit care.

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