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How long should we wait for patients to wake up when they undergo targeted temperature management?

      Victims of cardiac arrest (CA) who have return of spontaneous circulation (ROSC), may remain comatose for a period of time [
      • Jørgensen E.
      • Holm S.
      The natural course of neurological recovery following cardiopulmonary resuscitation.
      ]. Despite our current understanding of the pathophysiology of CA, and the new therapeutic interventions attempted for this clinical condition, many of these patients will develop some degree of permanent neurological impairment [
      • Jørgensen E.
      • Holm S.
      The natural course of neurological recovery following cardiopulmonary resuscitation.
      ]. Predicting neurological outcome in these patients remains very difficult and challenging at best [
      • Sandroni C.
      • Cavallaro F.
      • Callaway C.
      • et al.
      Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 1: patients not treated with therapeutic hypothermia.
      ].
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      References

        • Jørgensen E.
        • Holm S.
        The natural course of neurological recovery following cardiopulmonary resuscitation.
        Resuscitation. 1998; 36: 111-122
        • Sandroni C.
        • Cavallaro F.
        • Callaway C.
        • et al.
        Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 1: patients not treated with therapeutic hypothermia.
        Resuscitation. 2013; 84: 1310-1323
        • Ponz I.
        • Lopez-de-Sa E.
        • Armada E.
        • et al.
        Influence of the temperature on the moment of awakening in patients treated with therapeutic hypothermia after cardiac arrest.
        Resuscitation. 2016; 103: 32-36
        • Jørgensen E.
        • Holm S.
        Prediction of neurological outcome after cardiopulmonary resuscitation.
        Resuscitation. 1999; 41: 145-152
        • Grossestreuer A.
        • Abella B.
        • Leary M.
        • et al.
        Time to awakening and neurologic outcome in therapeutic hypothermia-treated cardiac arrest patients.
        Resuscitation. 2013; 84: 1741-1746
        • Callaway C.
        • Donnino M.
        • Fink E.
        • et al.
        American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Part 8: post–cardiac arrest care.
        Circulation. 2015; 2015: S465-S482
        • Nolan J.
        • Soar J.
        • Cariou A.
        • et al.
        European resuscitation council and European society of intensive care medicine 2015 guidelines for post-resuscitation care.
        Intensive Care Med. 2015; 41: 2039-2056
        • Lybeck A.
        • Cronberg T.
        • Aneman A.
        • et al.
        Time to awakening after cardiac arrest and the association with target temperature management.
        Resuscitation. 2018; 126: 166-171
        • Jiang J.Y.
        • Gao G.Y.
        • Li W.P.
        • Yu M.K.
        • Zhu C.
        Early indicators of prognosis in 846 cases of severe traumatic brain injury.
        J Neurotrauma. 2002; 19 (PMID 12184856): 869-874
        • Vespa P.
        • Miller C.
        • McArthur D.
        Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis.
        Crit Care Med. 2007; 35: 2830-2836
        • Nielsen N.
        • Wetterslev J.
        • Cronberg T.
        Targeted temperature management at 33 °C versus 36 °C after cardiac arrest.
        N Engl J Med. 2013; 369: 2197-2206
        • Polderman K.
        • Varon J.
        How low should we go? Hypothermia or strict normothermia after cardiac arrest?.
        Circulation. 2015; 131: 669-675
        • Polderman K.
        • Varon J.
        Confusion around therapeutic temperature management hypothermia after in-hospital cardiac arrest?.
        Circulation. 2018; 137: 219-221
        • Polderman K.
        • Varon J.
        We should not abandon therapeutic cooling after cardiac arrest.
        Crit Care. 2014; 18: 130
        • Gold B.
        • Puertas L.
        • Davis S.
        Awakening after cardiac arrest and post resuscitation hypothermia: are we pulling the plug too early?.
        Resuscitation. 2014; 85: 211-214
      1. Hypothermia after Cardiac Arrest Study Group: mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.
        N Engl J Med. 2002; 346: 549-556