Advanced Cardiovascular Life Support (ACLS) Practice Exam

Which condition is a contraindication to therapeutic hypothermia during the post-cardiac arrest period for patients who achieve return of spontaneous circulation (ROSC)?

1. Hypotension

2. Responding to verbal commands

3. Age greater than 75

4. Temperature above 38°C

The correct answer is: Responding to verbal commands

Therapeutic hypothermia, also known as targeted temperature management (TTM), is a procedure aimed at reducing the risk of neurological damage after cardiac arrest by lowering the patient's body temperature. However, certain conditions can contraindicate the use of therapeutic hypothermia. When a patient is responding to verbal commands, it indicates a relatively favorable neurological status. This responsiveness suggests that the brain is not significantly injured and that the patient may not benefit from hypothermia to mitigate neurological injury. The goal of therapeutic hypothermia is primarily for patients who are not neurologically intact, wherein there is a higher risk of complications from ischemic events during and after the cardiac arrest. In contrast, hypotension does not inherently contraindicate therapeutic hypothermia; in fact, managing hypotension is crucial as cooling can affect hemodynamic status. An age greater than 75 years is not an absolute contraindication, as hypothermia can still be beneficial in elderly patients. A temperature above 38°C is a concern because active cooling is intended to bring the body temperature down to a predefined range; thus, if a patient is already febrile, it may be necessary to address the fever before instituting hypothermia. Thus, the condition of responding to