The use of therapeutic hypothermia decreased in a large US registry of patients with out-of-hospital cardiac arrest soon after the publication of a study supporting more lenient temperature thresholds.

Concurrent with this change, overall survival of cardiac arrest among patients admitted to the hospital decreased, but survival was not explained by patient-level or hospital-level trends in the use of therapeutic hypothermia.

These findings raise concern for a potential change in clinical practice away from guideline-recommended active cooling after out-of-hospital cardiac arrest.

Among 45 935 patients (17 515 women and 28 420 men; mean [SD] age, 59.3 [18.3] years) who experienced out-of-hospital cardiac arrest and survived to admission at 649 US hospitals, overall use of therapeutic hypothermia during the study period was 46.4%.

In unadjusted analyses, the use of therapeutic hypothermia dropped from 52.5% in the last quarter of 2013 to 46.0% in the first quarter of 2014 after the December 2013 publication of the Targeted Temperature Management trial.

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