Targeted temperature management: State of the Art

Abstract

One of the indicated elements of post-resuscitation care is therapeutic hypothermia or temperature treatment management. the survivability of out-of-hospital cardiac arrest (OHCA) till admission to hospital is only 23%. Efficient thermoregulatory mechanisms are the basis for maintaining optimal body temperature. Therapeutic hypothermia shows normalizing effect on metabolic processes disturbed in ischaemic conditions, including improving metabolism and maintaining glucose balance in the brain, lowering the concentration of lactates, limiting the secretion of free radicals in damaged neurons, lowering the production of pro-inflammatory cytokines, stabilizes the blood-brain barrier and reduces endothelial dysfunction preventing ischaemic damage to tissues and organs. Hypothermia has a wide multidirectional effect on the human body, which can be useful in patients. Most available scientific studies show the efficacy and benefits of hypothermia in patients with out-of-hospital sudden cardiac arrest, including especially with ventricular fibrillation. The delay in the initiation of therapeutic hypothermia and reaching target temperature significantly increased the odds of a poor neurological outcome. Current American Heart Association (AHA) and European Resuscitation Council (ERC) resuscitation guidelines recommend that targeted temperature management should be implemented in all adult coma patients with return of spontaneous circulation (ROCS) after sudden cardiac arrest. The target temperature should be between 32°C and 36°C and then maintained for at least 24 hours. In patients with coma after TTM, fever should be actively prevented. For patients with out-of-hospital cardiac arrest, it is not recommended to routinely cool patients in prehospital conditions with a rapid intravenous infusion of cold fluids after ROSC.

ETView VivaSight single lumen vs. conventional intubation in simulated studies: a systematic review and meta-analysis

“…The remaining 13 articles were excluded for the following reasons: two were not RCT designs, two were a different study design, eight used different devices, and one was a human study. Eleven studies were therefore finally included in the systematic review [11][12][13][14][15][18][19][20][21][22][23] (Figure 1).…”

“…The characteristics of the included articles are summarized in Table 1. All studies were randomized crossover trials using manikins, [12][13][14][15][18][19][20][21][22][23] except for one cadaver study. 11 Four studies were original research articles, 11,12,14,15 five were correspondence to the editor, 13,[18][19][20][21] and two were poster presentations.…”

“…11 Four studies were original research articles, 11,12,14,15 five were correspondence to the editor, 13,[18][19][20][21] and two were poster presentations. 22,23 The 11 studies included 558 participants and 3,254 total intubations in 19 situation scenarios. Two trials 18,20 in car scenarios were continuation studies undertaken by the same participants, and 513 participants were therefore included in the analyses.…”

“…However, considering each scenario in a crossover study as an individual parallel study increased the number of participants to 1116. The participants in four studies were physicians, 14,15,22,23 six were paramedics, [11][12][13][18][19][20] and one study involved medical students. 21 No participants had any previous experience with the ETView, and limited experience with cETT intubation in clinical settings (<5 to 19), except in two studies with the same participant in a car scenario 18,20 where the participant had a mean of 9.4 career years as a healthcare provider, including experience with approximately 50 tracheal intubations in patients.…”

Should targeted temperature management be used in cardiogenic shock patients? Systematic review and meta-analysis

“…In this regard, targeted temperature management (TTM) through therapeutic hypothermia (32°C -34°C for 12 to 24 hours by surface cooling or endovascular cooling) has been investigated in several studies [6][7][8][9]. This level of hypothermia has a potentially neuroprotective effect [10,11]. It works by reducing the brain's metabolism and thus the oxygen, adenosine triphosphate, and glucose consumption, which are associated with reducing reperfusion injury [6,9].…”