In Reply We are pleased to respond to Freeman et al in the letter concerning our Viewpoint1 titled “Therapeutic Hypothermia After Cardiac Arrest Without Return of Consciousness: Skating on Thin Ice.” We concluded our Viewpoint with a call to commit resources to rigorously establishing the value of a novel therapy before its premature adoption. The 2 randomized clinical trials referenced by Freeman et al and analyzed by us in the Viewpoint had major shortcomings yet serve as the basis for the widespread use of therapeutic hypothermia (TH). As detailed in the Viewpoint, the International Liaison Committee on Resuscitation had only a thin evidence base for its recommendation. Widespread adoption of treatment strategies where the patient has no possibility of input, such as TH, demand more rigorous evidence than those where shared decision making can take place. In the absence of patient autonomy, we believe clinicians must continue to advocate for solid evidence of effectiveness.
Little NE, Feldman EL. Therapeutic Hypothermia and Targeted Temperature Management After Cardiac Arrest—Reply. JAMA Neurol. 2014;71(12):1578. doi:10.1001/jamaneurol.2014.3128