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| Item | Evidence | Recommendation grade |
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| Mild hypothermia therapy | Indications: Mild hypothermia therapy should be implemented as soon as possible for adult patients who recover spontaneous circulation but are still in a coma after cardiac arrest. | Grade A |
| Contraindications: No absolute contraindications. The relative contraindications include severe infection, uncontrollable bleeding, and intractable shock. | Grade A |
| Place of implementation: With necessary support, it can be initiated in pre-hospital settings, emergencyrooms, and ICUs. | Grade A |
| Implementation personnel: It is recommended that the on-site medical staff who have received the training on mild hypothermia therapy start the treatment as soon as possible without the specialist consultation. | Grade A |
| Start time: It should be initiated within 6 hours after the recovery of autonomic circulation, and the earlier, the better. If inevitable delay occurs due to various reasons, it may still be beneficial within 8 or more hours after the recovery of autonomic circulation. | Grade A |
| Target temperature: 33°C (32°C-34°C) is recommended for patients in a deep coma, or with evidence of brain edema or malignant EEG waveform. Otherwise, the recommended temperature is <36°C (32°C-36°C). | Grade B |
| Cooling measures: The whole-body hypothermia technique with temperature feedback control device or intravascular hypothermia technique or locally induced hypothermia (head) which gradually spreads to the whole body. If the medical conditions are undesirable, ice blanket, ice cap, and other treatments can be used. In case of cardiac insufficiency or risk of pulmonary edema, be careful to use 4°C normal saline intravenous infusion for induction. | Grade B |
| Duration of induced hypothermia: The target temperature shall be reached as soon as possible, and the recommended duration is 2-4 hours. | Grade B |
| Duration of hypothermia maintenance: 24 hours are recommended. | Grade B |
| Temperature monitoring method: Bladder or rectum temperature monitoring is the first choice, and nasopharynx, esophagus, bladder, endotracheal tube cuff, and pulmonary artery are recommended as the core monitoring sites. | Grade A |
| Interruption of mild hypothermia therapy: It is recommended to interrupt mild hypothermia therapy for patients with unstable hemodynamics, ineffective active resuscitation, and severe bleeding during treatment | Grade B |
| Rewarming | Rewarming speed: 0.25°C-0.5 °C/h is recommended | Grade B |
| Temperature requirement after rewarming: <37.5 °C | Grade B |
| Duration of maintenance after rewarming: Rewarming shall be maintained until 72 hours after resuscitation | Grade B |
| Prevention of mild hypothermia-related complications | Evaluation and control of shivering: Bedside shivering assessment scale (BSAS) and continuous EEG monitoring assessment are selected. It is recommended to administrate muscle relaxant buspirone (load: 30 mg; maintenance dose: 15 mg, once every 8 h), midazolam (load: 0.1 mg/kg; maintenance dose: 2-6 mg/h) and pethidine hydrochloride (load: 1 mg/kg; maintenance dose: 25-45 mg/h) alone or in combination. If shivering is not controlled as expected or rapid cooling occurs, vecuronium bromide (load: 0.03-0.05 mg/kg; maintenance dose: 0.02-0.03 mg/kg·h) or rocuronium bromide (load 0.6 mg/kg, maintenance dose 0.3-0.6 mg/kg·h) should be added. It is not recommended to routinely use anticonvulsant drugs to prevent epilepsy. At the same time, active body surface warming should be made and sedation and analgesia should be provided. | Grade B |
| Monitoring and treatment of arrhythmia: Monitor ECG, carefully use drugs that can prolong QTc interval, and use antiarrhythmic drugs for arrhythmias that are malignant or seriously affect hemodynamics. If bradycardia occurs, routine treatment is not recommended unless it leads to hemodynamic instability. | Grade B |
| Monitoring and control of infection: It is not allowed to use procalcitonin to diagnose infection during mild hypothermia therapy, and antibiotics are also prohibited. It is recommended to operate in strict accordance with disinfection procedures. | Grade B |
| Monitoring of serum potassium level: The recommended serum potassium level is >3.0 mmol/L. | Grade B |
| Prevention of other complications: Low metabolic rate, abnormal blood glucose, cold diuresis, hemodynamic instability, coagulation disorder, and decreased drug clearance may occur. Therefore, the patients should be closely monitored and actively treated. | Grade B |
| Nutritional support | Enteral nutrition: Enteral nutrition support is recommended during mild hypothermia therapy. | Grade A |
| Energy intake: It is recommended to keep the energy intake up to 75% of the target value under normal body temperature during mild hypothermia therapy. | Grade B |
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