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Chloride in targeted temperature management: Where is the data?

Published:January 15, 2021DOI:https://doi.org/10.1016/j.ajem.2021.01.029
      Out of hospital cardiac arrest (OHCA) remains the leading cause of mortality in the World, with a documented good neurological outcome survival rate of less than 5% [
      • Bernard S.A.
      • Gray T.W.
      • Buist M.D.
      • et al.
      Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.
      ]. One therapeutic intervention that may increase the survival chances of these patients, as well as reasonable neurological outcomes, has been the early implementation of targeted temperature management (TTM) [
      • Varon J.
      Therapeutic hypothermia in cardiac arrest: 206 years later!.
      ]. During the three phases of TTM, the patient is closely monitored in an attempt to avoid complications and improve their outcome. [
      • Varon J.
      • Acosta P.
      Therapeutic hypothermia: past, present, and future.
      ] TTM routinely leads to electrolyte disturbances, such as hypomagnesemia and hypokalemia, and these electrolytes require careful monitoring [
      • Polderman K.H.
      Of ions and temperature: the complicated interplay of temperature, fluids, and electrolytes on myocardial function.
      ]. It is well known that disturbances of such electrolytes, lead to higher mortality rates in the intensive care unit (ICU) settings [
      • Polderman K.H.
      • Peerdeman S.M.
      • Girbes A.R.
      Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury.
      ,
      • Polderman K.H.
      • Bloemers F.W.
      • Peerdeman S.M.
      • Girbes A.R.
      Hypomagnesemia and ypophosphatemia at admission in patients with severe head injury.
      ].

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