Targeted Temperature Management in Survivors of Cardiac Arrest

Silva, Ivan Rocha Ferreira da; Frontera, Jennifer A.

doi:10.1016/j.ccl.2013.07.010

Cited by 6 publications

(4 citation statements)

References 160 publications

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“…[193] In addition, these results indicate that the questions of which patient groups are eligible for TH treatment, which is the optimal core temperature, the duration and onset of cooling and which cooling technique should be used are still not fully answered. [194][195][196][197][198][199][200]…”

Section: Paper IIImentioning

confidence: 99%

Good outcome in every fourth resuscitation attempt is achievable—An Utstein template report from the Stavanger region

et al. 2011

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Section: Paper IIImentioning

confidence: 99%

Good outcome in every fourth resuscitation attempt is achievable—An Utstein template report from the Stavanger region

et al. 2011

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“…20,[61][62][63] Type and timing of methods for neurologic prognostication (somatosensory-evoked potentials, electroencephalography, serum neuronal-specific enolase, and brain imaging) should also be included. 61,[64][65][66] The TTM trial provides robust evidence that targeting a temperature of 36°C is equivalent to targeting 33°C. 4 In the absence of proven benefit from the lower temperature target, it is reasonable to favor the more conservative approach.…”

Section: When Should Cooling Be Initiated?mentioning

confidence: 99%

“…Rates of rewarming ranging from 0.5 to 0.1°C per hour until reaching a temperature of 36.5 or 37°C are typically prescribed. 4, 54,61,64 However, it is unknown if these durations of maintenance of hypothermia and rewarming are optimal. The ongoing Timedifferentiated Therapeutic Hypothermia (TTH48) trial (NCT01689077) is randomizing patients with out-of-hospital cardiac arrest to 33°C for 24 hours or 48 hours to determine if more prolonged hypothermia can improve neurological outcomes.…”

Section: How Long Should Cooling Be Continued?mentioning

confidence: 99%

How Cool It Is: Targeted Temperature Management for Brain Protection Post–Cardiac Arrest

Rabinstein

2016

Semin Respir Crit Care Med

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Neurological recovery often determines outcome in patients resuscitated after cardiac arrest. Temperature control as a neuroprotective strategy has become standard of care. The first randomized trials showing improved neurological outcomes in patients treated with hypothermia with a target temperature of 33°C over a decade ago led to the inclusion of this intervention in practice guidelines and the broad adoption of hypothermia protocols across the world. More recently, large randomized trials showed no difference from targeting a temperature of 33 or 36°C and no benefit from pre-hospital induction of hypothermia. Temperature control remains a crucial part of post-cardiac arrest care. However, the optimal temperature target, timing of induction, duration of temperature control, and speed of rewarming are unclear. Similarly, the value of targeted temperature management in cases of in-hospital arrest and non-shockable rhythms is unknown. This article reviews the neuroprotective mechanisms of hypothermia, the evidence supporting targeted temperature management after cardiac resuscitation, areas of persistent uncertainty and controversy, and future research directions.

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“…If the patient is allowed to get too "hot" the benefits of TTM may be limited. 28,29 . 30 This systematic review and meta-analysis gives some insight into the risk of bleeding complications associated with TTM.…”

Section: Implications For Practicementioning

confidence: 99%

Does therapeutic temperature management after cardiac arrest increase the risk of bleeding?

Williams

McKenzie

Inoue

2015

Australian Critical Care

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Cardiac arrest is a significant public health issue, with a high case fatality (>90% overall). 1 Guidelines recommend targeted temperature management (TTM) in the post-resuscitation care of patients who have suffered a cardiac arrest. 2-5 Several studies 6-8 have shown improved survival and neurological outcomes with the use of therapeutic hypothermia, also known as TTM. 9 Possible complications of TTM include bleeding, shivering and infection. 10-12 Hypothermia-induced coagulation disorder could enhance the risk for serious adverse events. 5,12-14 but it is unclear if bleeding complications occur more often in patients suffering cardiac arrest who have TTM. This report critiques a systematic review and meta-analysis that examined the relationship of bleeding with TTM: Therapeutic temperature management after cardiac arrest and the risk of bleeding: Systematic review and meta-analysis for the effect of therapeutic temperature management after cardiac arrest. 10 Study summary Aim: The systematic review and meta-analysis aimed to examine whether TTM after cardiac arrest increased the risk of bleeding. Method: Data for the systematic review and meta-analysis were obtained by a systematic literature search in September 2013 using MEDLINE, EMBASE and CENTRAL databases. The level of evidence and quality were assessed using the International Liaison Committee on Resuscitation (ILCOR) Guidelines. The risk of bleeding while receiving TTM or no TTM was examined in two meta-analyses. Results: Of 941 studies, 34 met the selection criteria and were included in the systematic review. Bleeding was found to be higher in patients treated with TTM (RR: 1.30, 95% CI: 0.97-1.74) in a meta-analysis of 5 studies (599 patients) but this did not reach statistical significance (p = 0.085). In a second meta-analysis of bleeding requiring transfusion (7 studies, 599 patients), there was no significant difference in the incidence of severe bleeding (RR 0.97, 95% CI: 0.61-1.56, p = 0.909). Conclusion: The risk of bleeding was not significantly higher for patients undergoing TTM. Regarding the risk of bleeding, the authors asserted that TTM is a safe method for patients after cardiac arrest.

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Targeted Temperature Management in Survivors of Cardiac Arrest

Cited by 6 publications

References 160 publications

Good outcome in every fourth resuscitation attempt is achievable—An Utstein template report from the Stavanger region

Good outcome in every fourth resuscitation attempt is achievable—An Utstein template report from the Stavanger region

How Cool It Is: Targeted Temperature Management for Brain Protection Post–Cardiac Arrest

Does therapeutic temperature management after cardiac arrest increase the risk of bleeding?

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