نبذة مختصرة : Introduction: Cardiac arrest is a significant global health challenge, which leads to substantial morbidity and mortality, impacting 50 to 100 individuals per 100,000 in the general population. Ischemic heart disease is the primary cause, particularly in developed countries. Historically, survival rates following cardiac arrest with a good neurological outcome were low; however, advancements in emergency response, including early Cardio-Pulmonary Resuscitation (CPR), access to defibrillation, coronary revascularisation, intensive care and Targeted Temperature Management (TTM), have notably improved patient outcomes. The practice of TTM has evolved over the past two decades, advocating that Therapeutic Hypothermia (TH) enhances neurological outcomes; although there has been much controversy over optimal temperature ranges. Notwithstanding, international resuscitation guidelines continue to endorse TTM as a post-resuscitation neuroprotective strategy, recommending temperatures between 32° and 36° Celsius. To ensure patient comfort and prevent shivering during the administration of TTM, sedatives and neuromuscular blockers are administered, preventing an accurate neurological assessment. Despite the challenges of neurological prognostication post-cardiac arrest, current guidelines recommend a multimodal approach, including clinical examination, electrophysiological studies, biomarkers, and neuroimaging, to predict outcomes accurately. Aim: This research sought to develop and evaluate a protocol (Therapeutic Hypothermia and eArly Waking, THAW) for early waking of unconscious Out-of-Hospital-Cardiac-Arrest (OHCA) survivors for the purpose of performing a comprehensive neurological assessment. Methods: A mixed methods approach was used. In the development of the THAW protocol, qualitative data were obtained from a series of focus groups, which included the research team, the National Health Service Ethics committee, a clinical expert panel, OHCA survivors and their family
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