Efectividad de la hipotermia terapéutica en la recuperación neurológica de pacientes postparto cardíaco: una revisión sistemática
Effectiveness of therapeutic hypothermia in neurological recovery of postcardiac arrest patients: a systematic review
DOI:
https://doi.org/10.56712/latam.v7i3.6126Palabras clave:
paro cardiaco, regulación de la temperatura corporal, temperatura corporal, hipotermia inducidaResumen
La hipotermia terapéutica (HT) se ha planteado como estrategia neuroprotectora en el cuidado post-paro cardíaco. Estudios iniciales mostraron beneficios en supervivencia y función neurológica, lo que impulsó su inclusión en guías internacionales. No obstante, evidencia reciente presenta resultados heterogéneos y, en muchos casos, sin mejoras significativas en mortalidad, ni recuperación neurológica. Evaluar la efectividad de la HT en la recuperación neurológica de pacientes adultos post-paro cardíaco, así como las limitaciones de los protocolos y el rol de enfermería en su aplicación. Revisión sistemática de estudios publicados entre 2020 y 2025 en bases de datos científicas internacionales, incluyendo ensayos clínicos, observacionales, revisiones sistemáticas, narrativas y cualitativos. La HT no garantiza beneficios universales. Su efectividad depende de inicio precoz, mantenimiento de la temperatura entre 32–36°C, duración de 12–24 h y recalentamiento progresivo. Se identificaron limitaciones como baja adherencia a protocolos y complicaciones frecuentes, entre ellas arritmias, infecciones y alteraciones metabólicas. Conclusiones: La HT debe aplicarse de manera personalizada y multidisciplinaria, evitando su uso indiscriminado. Futuras investigaciones deben definir los perfiles con mayor beneficio y fortalecer la estandarización de la técnica.
Citas
Ahn, S., An, M., Yoo, S.-H., & Park, H. (2023). Factors affecting the occurrence of pressure injuries among patients receiving targeted temperature management after cardiac arrest. Australian Critical Care, 36(3), 313–319. https://doi.org/10.1016/j.aucc.2022.03.005
Arksey, H., & O’Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
Awad, A., Jonsson, M., Holgersson, J., Jakobsen, J. C., Hollenberg, J., Thomas, M., Garcia, P. D. W., Ringh, M., Grejs, A. M., Keeble, T. R., Bělohlávek, J., Cariou, A., Annoni, F., Lilja, G., Taccone, F. S., Rylander, C., Nielsen, N., Dankiewicz, J., & Nordberg, P. (2025). Intravascular vs. surface cooling in out-of-hospital cardiac arrest patients receiving hypothermia after hospital arrival: a post hoc analysis of the TTM2 trial. Intensive Care Medicine, 51(4), 721–730. https://doi.org/10.1007/s00134-025-07883-4
Bisht, A., Gopinath, A., Cheema, A. H., Chaludiya, K., Khalid, M., Nwosu, M., Agyeman, W. Y., & Arcia Franchini, A. P. (2022). Targeted Temperature Management After Cardiac Arrest: A Systematic Review. Cureus. https://doi.org/10.7759/cureus.29016
Callaway, C. W., Coppler, P. J., Faro, J., Puyana, J. S., Solanki, P., Dezfulian, C., Doshi, A. A., Elmer, J., Frisch, A., Guyette, F. X., Okubo, M., Rittenberger, J. C., & Weissman, A. (2020). Association of Initial Illness Severity and Outcomes After Cardiac Arrest With Targeted Temperature Management at 36 °C or 33 °C. JAMA Network Open, 3(7), e208215. https://doi.org/10.1001/jamanetworkopen.2020.8215
Ceric, A., Dankiewicz, J., Cronberg, T., Düring, J., Moseby-Knappe, M., Annborn, M., May, T. L., Thomas, M., Grejs, A. M., Rylander, C., Belohlavek, J., Wendel-Garcia, P., Haenggi, M., Schrag, C., Hilty, M. P., Keeble, T. R., Wise, M. P., Young, P., Taccone, F. S., … Nielsen, N. (2025). Sedation and analgesia in post-cardiac arrest care: a post hoc analysis of the TTM2 trial. Critical Care, 29(1), 247. https://doi.org/10.1186/s13054-025-05461-0
Chen, D., Lin, Y., Ko, P., Lin, J., Huang, C., Wang, G., & Chang, K.-C. (2024). Effect of targeted temperature management on systemic inflammatory responses after out-of-hospital cardiac arrest: A prospective cohort study. Medicine, 103(38), e39780. https://doi.org/10.1097/MD.0000000000039780
Chen, S., Lachance, B. B., Gao, L., & Jia, X. (2021). Targeted temperature management and early neuro-prognostication after cardiac arrest. Journal of Cerebral Blood Flow & Metabolism, 41(6), 1193–1209. https://doi.org/10.1177/0271678X20970059
Chiu, P.-Y., Chung, C.-C., Tu, Y.-K., Tseng, C.-H., & Kuan, Y.-C. (2023). Therapeutic hypothermia in patients after cardiac arrest: A systematic review and meta-analysis of randomized controlled trials. The American Journal of Emergency Medicine, 71, 182–189. https://doi.org/10.1016/j.ajem.2023.06.040
Chiu, W.-T., Chung, C.-C., Huang, C.-H., Chien, Y., Hsu, C.-H., Wu, C.-H., Wang, C.-H., Chiu, H.-W., & Chan, L. (2022). Predicting the survivals and favorable neurologic outcomes after targeted temperature management by artificial neural networks. Journal of the Formosan Medical Association, 121(2), 490–499. https://doi.org/10.1016/j.jfma.2021.07.004
Costa, L. S. S. da, Raponi, M. B. G., & Leão, E. R. (2025). Evaluation of the johns hopkins evidence-based practice model: a preliminary study with clinical nurses. Texto & Contexto - Enfermagem, 34, e20240268. https://doi.org/10.1590/1980-265x-tce-2024-0268en
Dillenbeck, E., Hollenberg, J., Holzer, M., Busch, H.-J., Nichol, G., Radsel, P., Belohlavec, J., Torres, E. C., López-de-Sa, E., Rosell, F., Ristagno, G., Forsberg, S., Annoni, F., Svensson, L., Jonsson, M., Bäckström, D., Gellerfors, M., Awad, A., Taccone, F. S., & Nordberg, P. (2024). The design of the PRINCESS 2 trial: A randomized trial to study the impact of ultrafast hypothermia on complete neurologic recovery after out-of-hospital cardiac arrest with initial shockable rhythm. American Heart Journal, 271, 97–108. https://doi.org/10.1016/j.ahj.2024.02.020
Hadie, S. N. H. (2024). ABC of a Scoping Review: A Simplified JBI Scoping Review Guideline. Education in Medicine Journal, 16(2), 185–197. https://doi.org/10.21315/eimj2024.16.2.14
Hsu, T.-H., Huang, W.-C., Lin, K.-C., Huang, C.-L., Tai, H.-Y., Tsai, Y.-C., Wu, M.-C., & Chang, Y.-T. (2023). Impact of a targeted temperature management quality improvement project on survival and neurologic outcomes in cardiac arrest patients. Journal of the Chinese Medical Association, 86(7), 672–681. https://doi.org/10.1097/JCMA.0000000000000939
Kikutani, K., Nishikimi, M., Matsui, K., Sakurai, A., Hayashida, K., Kitamura, N., Tagami, T., Nakada, T., Matsui, S., Ohshimo, S., & Shime, N. (2024). Prediction of the neurological outcomes post-cardiac arrest: A prospective validation of the CAST and rCAST. The American Journal of Emergency Medicine, 75, 46–52. https://doi.org/10.1016/j.ajem.2023.10.028
Kim, J.-G., Shin, H., Lim, T.-H., Kim, W., Cho, Y., Jang, B.-H., Choi, K.-S., Na, M.-K., Ahn, C., & Lee, J. (2022). Efficacy of Quantitative Pupillary Light Reflex for Predicting Neurological Outcomes in Patients Treated with Targeted Temperature Management after Cardiac Arrest: A Systematic Review and Meta-Analysis. Medicina, 58(6), 804. https://doi.org/10.3390/medicina58060804
Lee, C.-C., Cheuh, H.-Y., & Chang, S.-N. (2023). The Identification of Subsequent Events Following Out-of-Hospital Cardiac Arrests with Targeted Temperature Management. Acta Cardiologica Sinica, 39(6), 831–840. https://doi.org/10.6515/ACS.202311_39(6).20230529B
Lee, H.-Y., Tien, Y.-T., Huang, C.-H., Chen, W.-J., Chen, W.-T., Chang, W.-T., Ong, H.-N., & Tsai, M.-S. (2024). The compliance with TTM protocol may benefit outcomes in cardiac arrest survivors: A retrospective cohort study. The American Journal of Emergency Medicine, 84, 87–92. https://doi.org/10.1016/j.ajem.2024.07.038
Lee, Z. H., Kim, Y. H., Lee, J. H., Lee, D. W., Lee, K. Y., & Hwang, S. Y. (2020). Association between Cardiac Arrest Time and Favorable Neurological Outcomes in Witnessed Out-of-Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management. Journal of Korean Medical Science, 35(17). https://doi.org/10.3346/jkms.2020.35.e108
Lin, J.-J., Huang, C.-H., Chien, Y.-S., Hsu, C.-H., Chiu, W.-T., Wu, C.-H., Wang, C.-H., & Tsai, M.-S. (2023). TIMECARD score: An easily operated prediction model of unfavorable neurological outcomes in out-of-hospital cardiac arrest patients with targeted temperature management. Journal of the Formosan Medical Association, 122(4), 317–327. https://doi.org/10.1016/j.jfma.2022.11.012
Lüsebrink, E., Binzenhöfer, L., Kellnar, A., Scherer, C., Schier, J., Kleeberger, J., Stocker, T. J., Peterss, S., Hagl, C., Stark, K., Petzold, T., Fichtner, S., Braun, D., Kääb, S., Brunner, S., Theiss, H., Hausleiter, J., Massberg, S., & Orban, M. (2022). Targeted Temperature Management in Postresuscitation Care After Incorporating Results of the TTM2 Trial. Journal of the American Heart Association, 11(21). https://doi.org/10.1161/JAHA.122.026539
Manasia, R. J. M., Husain, S. J., Hooda, K., Imran, M., & Bailey, C. (2014). Therapeutic hypothermia post-cardiac arrest: A clinical nurse specialist initiative in Pakistan. Clinical Nurse Specialist, 28(4), 231–239. https://doi.org/10.1097/NUR.0000000000000057
Manterola, C., Asenjo-Lobos, C., & Otzen, T. (2014). Jerarquización de la evidencia: Niveles de evidencia y grados de recomendación de uso actual. Revista chilena de infectología, 31(6), 705–718. https://doi.org/10.4067/S0716-10182014000600011
Meurer, W. J., Schmitzberger, F. F., Yeatts, S., Ramakrishnan, V., Abella, B., Aufderheide, T., Barsan, W., Benoit, J., Berry, S., Black, J., Bozeman, N., Broglio, K., Brown, J., Brown, K., Carlozzi, N., Caveney, A., Cho, S.-M., Chung-Esaki, H., Clevenger, R., … Zwank, M. D. (2024). Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP): study protocol for a multicenter, randomized, adaptive allocation clinical trial to identify the optimal duration of induced hypothermia for neuroprotection in comatose, adult survivors of after out-of-hospital cardiac arrest. Trials, 25(1), 502. https://doi.org/10.1186/s13063-024-08280-w
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Alonso-Fernández, S. (2021). Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Revista Española de Cardiología, 74(9), 790–799. https://doi.org/10.1016/j.recesp.2021.06.016
Sanfilippo, F., Uryga, A., Santonocito, C., Jakobsen, J. C., Lilja, G., Friberg, H., Wendel-Garcia, P. D., Young, P. J., Eastwood, G., Chew, M. S., Unden, J., Thomas, M., Grejs, A. M., Wise, M. P., Lundin, A., Hollenberg, J., Hammond, N., Saxena, M., Martin, A., … Robba, C. (2025). Effects of very early hyperoxemia on neurologic outcome after out-of-hospital cardiac arrest: A secondary analysis of the TTM-2 trial. Resuscitation, 207, 110460. https://doi.org/10.1016/j.resuscitation.2024.110460
Shin, K., Hirano, K., Hifumi, T., Soh, M., Shirasaki, K., Isokawa, S., Inoue, A., Sakamoto, T., Kuroda, Y., Otani, N., Takada, H., Inoue, K., & Hasegawa, E. (2025). Blood glucose levels in out-of-hospital cardiac arrest undergoing targeted temperature management and ECPR. The American Journal of Emergency Medicine, 89, 216–222. https://doi.org/10.1016/j.ajem.2024.12.068
Shrestha, D. B., Sedhai, Y. R., Budhathoki, P., Gaire, S., Adhikari, A., Poudel, A., Aryal, B. B., Yadullahi Mir, W. A., Dahal, K., & Kashiouris, M. G. (2022). Hypothermia versus normothermia after out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials. Annals of Medicine & Surgery, 74. https://doi.org/10.1016/j.amsu.2022.103327
Song, H., Bang, H. J., You, Y., Park, J. S., Kang, C., Kim, H. J., Park, K. N., Oh, S. H., & Youn, C. S. (2023). Novel serum biomarkers for predicting neurological outcomes in postcardiac arrest patients treated with targeted temperature management. Critical Care, 27(1), 113. https://doi.org/10.1186/s13054-023-04400-1
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2026 Jason David Ortiz Montero, Kevin Daniel Valenzuela Mireles, Genesis Monserrath Cuji Gutierrez, Jefferson Alexander Núñez Medina, Cristina Elizabeth Heredia Montenegro

Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.












