***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : Mild therapeutic hypothermia after out-of-hospital cardiac arrest is usually achieved either by surface cooling or by core cooling via the patient 's bloodstream . We compared modern core ( Coolgard ) and surface ( A rct ic Sun ) cooling devices with a zero hypothesis of equal cooling , complications , and neurologic outcomes . Design : Single-center observational study . Setting : University hospital medical and cardiac intensive care units . Patients : One hundred sixty-seven consecutive patients comatose after out-of-hospital cardiac arrest of all causes treated with mild therapeutic hypothermia in a 5-yr period . Interventions : Nonr and omized allocation to core or surface cooling depending on availability and physician preference . Measurements and Main Results : All out-of-hospital cardiac arrest patients ' records were review ed for relevant data regarding medical history , cardiac arrest event , prehospital care , in-hospital treatment , and complications . Survivor neurologic function was reassessed at follow-up after 6 to 12 months . Baseline patient and arrest episode characteristics were similar in the treatment groups . There was no significant difference in survival with good neurologic function , either to hospital discharge ( surface , 34/90 , 38 % ; core , 34/75 , 45 % ; p = .345 ) or at follow-up ( surface , 34/88 , 39 % ; core , 34/75 , 45 % ; p = .387 ) . Time from cardiac arrest to achieving mild therapeutic hypothermia was equal with both devices ( surface , 273 min , interquartile range 158–330 ; core , 270 min , interquartile range 190–360 ; p = .479 ) . There were significantly more episodes of sustained hyperglycemia among the surface-cooled patients ( surface , 64/92 , 70 % ; core , 36/75 , 48 % ; p = .005 ) and significantly more hypomagnesaemia among core-cooled patients ( surface , 16/87 , 18 % ; core , 27/74 , 37 % ; p = .01 ) . Conclusions : In this study , surface and core cooling of out-of-hospital cardiac arrest patients following the same established postresuscitation treatment protocol result ed in similar survival to hospital discharge and comparable neurologic function at follow-up Introduction Mild induced hypothermia ( MIH ) is indicated for comatose survivors of sudden cardiac arrest ( SCA ) to improve clinical outcome . In this study , we compared the efficacy of two different cooling devices for temperature management in SCA survivors . Methods Between April 2008 and August 2009 , 80 patients after survived in-hospital ( IHCA ) and out-of-hospital cardiac arrest ( OHCA ) were included in this prospect i ve , r and omized , single center study . Hypothermia was induced after r and omization by either invasive Coolgard ® cooling or non-invasive A rct icSun ® surface cooling at 33.0 ° C core body temperature for 24 h followed by active rewarming . The primary endpoint was defined as the efficacy of both cooling systems , measured by neuron-specific enolase ( NSE ) levels as a surrogate parameter for brain damage . Secondary efficacy endpoints were the clinical and neurological outcome , time to start of cooling and reaching the target temperature , target temperature-maintenance and hypothermia-associated complications . Results NSE at 72 h did not differ significantly between the 2 groups with 16.5 ng/ml , interquartile range 11.8–46.5 in surface-cooled patients versus 19.0 ng/ml , interquartile range 11.0–42.0 in invasive-cooled patients , p = 0.99 . Neurological and clinical outcome was similar in both groups . Target temperature of 33.0 ° C was maintained more stable in the invasive group ( 33.0 versus 32.7 ° C , p < 0.001 ) . Bleeding complications were more frequent with invasive cooling ( n = 17 [ 43.6 % ] versus n = 7 [ 17.9 % ] ; p = 0.03 ) . Conclusion Invasive cooling has advantages with respect to temperature management over surface cooling ; however , did not result in different outcome as measured by NSE release in SCA survivors . Bleeding complications were more frequently encountered by invasive cooling Background — Therapeutic hypothermia is recommended for the treatment of neurological injury after resuscitation from out-of-hospital cardiac arrest . Laboratory studies have suggested that earlier cooling may be associated with improved neurological outcomes . We hypothesized that induction of therapeutic hypothermia by paramedics before hospital arrival would improve outcome . Methods and Results — In a prospect i ve , r and omized controlled trial , we assigned adults who had been resuscitated from out-of-hospital cardiac arrest with an initial cardiac rhythm of ventricular fibrillation to either prehospital cooling with a rapid infusion of 2 L of ice-cold lactated Ringer 's solution or cooling after hospital admission . The primary outcome measure was functional status at hospital discharge , with a favorable outcome defined as discharge either to home or to a rehabilitation facility . A total of 234 patients were r and omly assigned to either paramedic cooling ( 118 patients ) or hospital cooling ( 116 patients ) . Patients allocated to paramedic cooling received a median of 1900 mL ( first quartile 1000 mL , third quartile 2000 mL ) of ice-cold fluid . This result ed in a mean decrease in core temperature of 0.8 ° C ( P=0.01 ) . In the paramedic-cooled group , 47.5 % patients had a favorable outcome at hospital discharge compared with 52.6 % in the hospital-cooled group ( risk ratio 0.90 , 95 % confidence interval 0.70 to 1.17 , P=0.43 ) . Conclusions — In adults who have been resuscitated from out-of-hospital cardiac arrest with an initial cardiac rhythm of ventricular fibrillation , paramedic cooling with a rapid infusion of large-volume , ice-cold intravenous fluid decreased core temperature at hospital arrival but was not shown to improve outcome at hospital discharge compared with cooling commenced in the hospital . Clinical Trial Registration — URL : http://www.anzctr.org.au . Unique identifier : ACTRN12605000179639 INTRODUCTION Hypothermia improves neurologic recovery compared to normothermia after resuscitation from out-of-hospital ventricular fibrillation , but may or may not be beneficial for patients resuscitated from in-hospital cardiac arrest . Therefore , we evaluated the effect of induced hypothermia in a large cohort of patients with in-hospital cardiac arrest . METHODS Retrospective analysis of multi-center prospect i ve cohort of patients with in-hospital cardiac arrest enrolled in an ongoing quality improvement project . Included were adults with a pulseless event in an in-patient hospital ward of a participating institution who achieved restoration of spontaneous circulation between 2000 and 2009 . The exposure of interest was induced hypothermia . The primary outcome was survival to discharge . The secondary outcome was neurological status at discharge . Analyses evaluated all eligible patients ; those with a shockable rhythm ; or those with endotracheal tube inserted after resuscitation ; and the effect of no hypothermia versus hypothermia ( lowest temperature>32 ° C but ≤34 ° C ) versus overcooled ( ≤32 ° C ) . Associations were assessed using propensity score methods . RESULTS Included were 8316 patients with complete data , of whom 214 ( 2.6 % ) had hypothermia induced and 2521 ( 30 % ) survived to discharge . Of patients reported to receive hypothermia , only 40 % were documented as achieving a temperature between 32 ° C and 34 ° C . Adjusted for known potential confounders using propensity score methods , induced hypothermia was associated with an odds ratio of survival of 0.90 ( 95 % confidence interval : 0.65 , 1.23 ; p-value=0.49 ) compared to no hypothermia . Induced hypothermia was associated with an odds ratio of neurologically-favorable survival of 0.93 ( 95 % confidence interval : 0.65 , 1.32 ; p-value=0.68 ) compared to no hypothermia . For patients with shockable first-recorded rhythm  , induced hypothermia was associated with an odds ratio of survival of 1.43 ( 95 % confidence interval : 0.68 , 3.01 ; p-value=0.35 ) compared to no hypothermia . CONCLUSION Hypothermia is induced infrequently in patients resuscitated from in-hospital cardiac arrest with only 40 % achieving target temperatures . Induced hypothermia was not associated with improved or worsened survival or neurologically-favorable survival . The lack of benefit in this population may reflect lack of effect , inefficient application of the intervention , or residual confounding . High- quality controlled studies are required to better characterize the effect of induced hypothermia in this population Background — Although delayed hospital cooling has been demonstrated to improve outcome after cardiac arrest , in-field cooling started immediately after the return of spontaneous circulation may be more beneficial . The aims of the present pilot study were to assess the feasibility , safety , and effectiveness of in-field cooling . Methods and Results — We determined the effect on esophageal temperature , before hospital arrival , of infusing up to 2 L of 4 ° C normal saline as soon as possible after resuscitation from out-of-hospital cardiac arrest . A total of 125 such patients were r and omized to receive st and ard care with or without intravenous cooling .  Of the 63 patients r and omized to cooling , 49 ( 78 % ) received an infusion of 500 to 2000 mL of 4 ° C normal saline before hospital arrival . These 63 patients experienced a mean temperature decrease of 1.24±1 ° C with a hospital arrival temperature of 34.7 ° C , whereas the 62 patients not r and omized to cooling experienced a mean temperature increase of 0.10±0.94 ° C ( P<0.0001 ) with a hospital arrival temperature of 35.7 ° C . In-field cooling was not associated with adverse consequences in terms of blood pressure , heart rate , arterial oxygenation , evidence for pulmonary edema on initial chest x-ray , or rearrest . Secondary end points of awakening and discharged alive from hospital trended toward improvement in ventricular fibrillation patients r and omized to in-field cooling . Conclusions — These pilot data suggest that infusion of up to 2 L of 4 ° C normal saline in the field is feasible , safe , and effective in lowering temperature . We propose that the effect of this cooling method on neurological outcome after cardiac arrest be studied in larger numbers of patients , especially those whose initial rhythm is ventricular fibrillation Purpose Mild therapeutic hypothermia ( TH ) is recommended as soon as possible after the return of spontaneous circulation to improve outcomes after out-of-hospital cardiac arrest ( OHCA ) . Pre clinical data suggest that the benefit of TH could be increased if treatment is started during cardiac arrest . We aim ed to study the impact of intra-arrest therapeutic hypothermia ( IATH ) on neurological injury and inflammation following OHCA . Methods We conducted a 1:1 r and omized , multicenter study in three prehospital emergency medical services and four critical care units in France . OHCA patients , irrespective of the initial rhythm , received either an infusion of cold saline and external cooling during cardiac arrest ( IATH group ) or TH started after hospital admission ( hospital-cooling group ) . The primary endpoint was neuron-specific enolase ( NSE ) serum concentrations at 24 h. Secondary endpoints included IL-6 , IL-8 , and IL-10 concentrations , and clinical outcome . Results Of the 245 patients included , 123 were analyzed in the IATH group and 122 in the hospital-cooling group . IATH  decreased time to reach temperature ≤34 ° C by 75 min ( 95 % CI : 4 ; 269 ) . The rate of patients admitted alive to hospital was not different between groups [ IATH n = 41 ( 33 % ) vs. hospital cooling n = 36 ( 30 % ) ; p = 0.51 ] . Levels of NSE and inflammatory biomarkers were not different between groups [ median NSE at 24 h : IATH 96.7 μg/l ( IQR : 49.9–142.8 ) vs. hospital cooling 97.6 μg/l ( IQR : 74.3–142.4 ) , p = 0.64 ] . No difference in survival and cerebral performance were found at 1 month . Conclusions IATH did not affect biological markers of inflammation or brain damage or clinical outcome Background — Although the level of evidence of improvement is significant in cardiac arrest patients resuscitated from a shockable rhythm ( ventricular fibrillation or pulseless ventricular tachycardia [ VF/VT ] ) , the use of therapeutic mild hypothermia ( TMH ) is more controversial in nonshockable patients ( pulseless electric activity or asystole [ PEA/asystole ] ) . We therefore assessed the prognostic value of hypothermia for neurological outcome at hospital discharge according to first-recorded cardiac rhythm in a large cohort . Methods and Results — Between 
    Output:
    
Targeted temperature management use did not benefit survivors of in-hospital cardiac arrest nor out-of-hospital cardiac arrest survivors with a non-shockable rhythm .
Moderate quality evidence demonstrated no benefit of pre-hospital targeted temperature management initiation .
Low quality evidence showed no difference between endovascular versus surface cooling targeted temperature management systems , nor any benefit of adding feedback control to targeted temperature management systems .