My personal policy: EVERYONE unless they are >37 degrees. Until such a time that a definite diagnosis can be identified to justify cooling (VERY rare). I.e. if they are 36.8 the blanket is to maintain their temp!
Cold patients consume more oxygen, clot less and there is no evidence that "mild hypothermia of neglect" is beneficial to cerebral outcomes!!!!
Worth clarifying your question here. If you're talking about "resuscitation" in the looser sense (resuscitation from a difficult surgery with heavy blood loss, lots of surgical insult, etc.), then agree that hypothermia at that point is best avoided. If on the other hand, you're talking about resuscitation from cardiac arrest, where a significant ischemia-reperfusion injury has occurred, then indeed, hypothermia is demonstrably indicated, and clearly improves outcomes (notwithstanding the equipoise that exists currently as to the optimal goal temperature to target). The equipoise on goal temperature has resulted in increased use of the term targeted temperature management, to acknowledge that temperatures even just a degree below normal body temperature, as long as they are maintained rigorously, can still yield significant neurologic benefit.
In fact, evidence supports the association between targeted temperature management and improved outcomes In ischemia-reperfusion injury (in particular, adults who remain comatose after resuscitation from cardiac arrest, and neonates suffering from hypoxic ischemic encephalopathy) is such that it is now considered a standard of care, endorsed internationally by the major resuscitative, cardiovascular care, neonatal care, and surgical standards groups (including the American Heart Association, the International Liaison Committee on Resuscitation, the European Resuscitation Council, the National Institute of Child Health and Human Development, the National Institute for Health and Care Excellence, the Centers for Medicare and Medicaid Services via the Surgical Care Improvement Project, and the American Society of Anesthesiologists, among others). [1-8]
As far as product-specific protocols, there isn't strong evidence to support one over another, but for general protocols for hypothermia, best source is the University of Pennsylvania site: http://www.med.upenn.edu/resuscitation/hypothermia/protocols.shtml
1. Higgins RD, Raju TN, Perlman J, Azzopardi DV, Blackmon LR, Clark RH, Edwards AD, Ferriero DM, Gluckman PD, Gunn AJ et al: Hypothermia and perinatal asphyxia: executive summary of the National Institute of Child Health and Human Development workshop. J Pediatr 2006, 148(2):170-175.
2. Blackmon LR, Stark AR: Hypothermia: a neuroprotective therapy for neonatal hypoxic-ischemic encephalopathy. Pediatrics 2006, 117(3):942-948.
3. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005, 112(24 Suppl):IV1-203-IV201-203.
4. Roehr CC, Hansmann G, Hoehn T, Buhrer C: The 2010 Guidelines on Neonatal Resuscitation (AHA, ERC, ILCOR): similarities and differences--what progress has been made since 2005? Klin Padiatr 2011, 223(5):299-307.
5. Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M, Gabrielli A, Silvers SM, Zaritsky AL, Merchant R et al: Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010, 122(18 Suppl 3):S768-786.
6. Nolan JP, Neumar RW, Adrie C, Aibiki M, Berg RA, Bottiger BW, Callaway C, Clark RS, Geocadin RG, Jauch EC et al: Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke. Resuscitation 2008, 79(3):350-379.
7. Deakin CD, Morrison LJ, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW et al: Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2010, 81 Suppl 1:e93-e174.
8. Nolan JP, Morley PT, Hoek TL, Hickey RW: Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison committee on Resuscitation. Resuscitation 2003, 57(3):231-235.
I think the key issue here is that we are talking really about two different patient populations. The accidentally hypothermic patient during or after surgery would likely have greater metabolic demands with the increased stress from inadvertent hypothermia and the consequent increased metabolic activity that is generated in order to combat it (particularly with shivering). On the other hand, post cardiac arrest, when there is purposeful induction of reduced temperature (whether you choose 36°C or 33°C, or somewhere in between, based on the current equipoise that exists around goal temperature), with proper sedation and monitoring, oxygen consumption and general metabolic activity decreases.