Targeted temperature management (TTM) after cardiac arrest has been in clinical practice
for almost two decades since the first randomized human evidence emerged in 2002.
1
,
2
Today international guidelines recommend TTM for out-of-hospital cardiac arrest (OHCA)
with the stronger recommendations for initial shockable rhythms.
3
The recommendations for OHCA are however based on low-quality evidence and for in-hospital
cardiac arrests (IHCA) on very low-quality evidence. Since the last iteration of guidelines
2015 and maybe also as an effect of the TTM-trial 2013,
4
the overall use of TTM has decreased.
5
,
6
However recently an almost 600-patient randomized clinical trial (RCT) suggested
better neurological outcome for patients with initial non-shockable rhythms in a population
of both IHCA and OHCA when cooled to 33 °C.
7
There are also ongoing trials that will further shed light on the future role of
TTM.
8
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References
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- European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015.Resuscitation. 2015; 95: 202-222
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- Temporal trends in the use of therapeutic hypothermia for out-of-hospital cardiac arrest.JAMA Netw Open. 2018; 1e184511
- Long-term survival in out-of-hospital cardiac arrest patients treated with targeted temperature control at 33 degrees C or 36 degrees C: a national registry study.Resuscitation. 2019; 143: 142-147
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- Effect of trans-nasal evaporative intra-arrest cooling on functional neurologic outcome in out-of-hospital cardiac arrest: the PRINCESS randomized clinical trial.JAMA. 2019; 321: 1677-1685
- Targeted temperature management for 48 vs 24 hours and neurologic outcome after out-of-hospital cardiac arrest: a randomized clinical trial.JAMA. 2017; 318: 341-350
- We should not abandon therapeutic cooling after cardiac arrest.Crit Care. 2014; 18: 130
- Targeted temperature management after out-of-hospital cardiac arrest: certainties and uncertainties.Crit Care. 2014; 18: 459
- Mechanisms of action, physiological effects, and complications of hypothermia.Crit Care Med. 2009; 37: S186-S202
- Intracerebral monitoring in comatose patients treated with hypothermia after a cardiac arrest.Acta Anaesthesiol Scand. 2009; 53: 289-298
- Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest.Acta Anaesthesiol Scand. 2009; 53: 926-934
- The influence of rewarming after therapeutic hypothermia on outcome after cardiac arrest.Resuscitation. 2012; 83: 996-1000
- Pilot study on a rewarming rate of 0.15 degrees C/hr versus 0.25 degrees C/hr and outcomes in post cardiac arrest patients.Clin Exp Emerg Med. 2019; 6: 25-30
- Association between rewarming duration and neurological outcome in out-of-hospital cardiac arrest patients receiving therapeutic hypothermia.Resuscitation. 2019;
- The impact of residual and unmeasured confounding in epidemiologic studies: a simulation study.Am J Epidemiol. 2007; 166: 646-655
Article info
Publication history
Published online: October 23, 2019
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2019 Elsevier B.V. All rights reserved.
