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We thank Dr Yan Kang and colleagues for their comments assuming that endovascular cooling may theoretically present more advantages than surface cooling. We agree with this assertion as we consider that automated devices control like endovascular cooling allow significant shortening in time-to-target temperature, better controlled maintenance and rewarming phases, and improvement in intensive care unit nurses’ workload as described in our trial.1 However, as reported in several studies, it is not clear whether reaching the targeted temperature more quickly may result in a better prognosis in post–cardiac arrest patients. Although demonstrated by most of animal studies,2 several clinical studies failed to prove any relationship between time-to-target temperature and final outcome.3 In contrast, studies even observed that the lower the time-to-target temperature, the worse the prognosis could be, suggesting that the more the brain is damaged, the more the thermoregulation is impaired leading to lower core temperature on admission.4 This …

circulation

Response to Letter Regarding Article, “Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest: A Randomized, Controlled Study”