Article
Clinical Neurology
Salvatore A. D'Amato, W. Taylor Kimberly, Stephan A. Mayer
Summary: This article reviews the use of targeted temperature management (TTM) in comatose survivors following cardiac arrest and discusses the recent failure to replicate earlier successes in clinical trials. The article emphasizes the importance of clinicians learning from other clinical scenarios and redeveloping clinical care in an environment where current data contradicts past results.
Article
Critical Care Medicine
Jean Baptiste Lascarrou, Florence Dumas, Wulfran Bougouin, Stephane Legriel, Nadia Aissaoui, Nicolas Deye, Frankie Beganton, Lionel Lamhaut, Daniel Jost, Antoine Vieillard-Baron, Graham Nichol, Eloi Marijon, Xavier Jouven, Alain Cariou
Summary: Recent guidelines suggest actively avoiding fever to improve outcomes in comatose patients post-cardiac arrest, but the use of targeted temperature management (TTM) between 32°C and 36°C remains controversial. This study aimed to assess the association between TTM and outcome based on severity at ICU admission using the mCAHP score. The results showed that TTM32-36 was associated with improved neurologic outcome in patients with low and high severity scores. Rating: 9/10
Article
Critical Care Medicine
Jean-Baptiste Lascarrou, Elie Guichard, Jean Reignier, Amelie Le Gouge, Caroline Pouplet, Stephanie Martin, Jean-Claude Lacherade, Gwenhael Colin, AfterROSC Network
Summary: Rewarming at 0.25 degrees C/h, compared to 0.50 degrees C/h, did not decrease serum IL6 levels after shockable cardiac arrest. Further studies are needed to determine the optimal TTM strategy.
Article
Critical Care Medicine
Kevin M. Wheelock, Paul S. Chan, Lian Chen, James A. de Lemose, P. Elliott Miller, Brahmajee K. Nallamothu, Saket Girotra, Rohan Khera
Summary: The study examined the adherence to temperature targets in comatose survivors of out-of-hospital cardiac arrest (OHCA) who underwent targeted temperature management (TTM) and its association with survival and neurological outcomes. The study found variability in adherence to guideline-recommended treatment targets, where higher time-in-therapeutic range (TTR) was associated with favorable neurological outcome but not overall survival. These findings suggest the importance of accurately maintaining the target temperature during TTM for improved neurological outcomes.
Review
Critical Care Medicine
Asger Granfeldt, Mathias J. Holmberg, Jerry P. Nolan, Jasmeet Soar, Lars W. Andersen
Summary: A systematic review and meta-analysis on targeted temperature management in adult cardiac arrest patients concluded that targeting 32-34 degrees Celsius did not lead to improved outcomes compared to normothermia. Initiating targeted temperature management before hospital arrival also showed no effect on survival or favorable neurologic outcomes. These findings suggest a need for updating international cardiac arrest guidelines.
Review
Cardiac & Cardiovascular Systems
Konstantin A. Krychtiuk, Christopher B. Fordyce, Carolina M. Hansen, Christian Hassager, Jacob C. Jentzer, Venu Menon, Sarah M. Perman, Sean van Diepen, Christopher B. Granger
Summary: Targeted temperature management (TTM) has been a cornerstone in the treatment of comatose post-cardiac arrest patients, but its efficacy remains controversial. Several trials have been conducted, and the results show no difference in outcomes between different temperature ranges for TTM. Therefore, the use of TTM needs to be cautious and further research is needed to support its efficacy.
EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
(2022)
Review
Medicine, General & Internal
Kazuya Kikutani, Mitsuaki Nishikimi, Tatsutoshi Shimatani, Michihito Kyo, Shinichiro Ohshimo, Nobuaki Shime
Summary: Current research suggests that hypothermic targeted temperature management (TTM) may not be superior to normothermic TTM in improving neurological outcomes in post-cardiac arrest syndrome (PCAS) patients. However, studies indicate that the efficacy of hypothermic TTM may vary based on the severity of PCAS, suggesting the potential for individualized treatment approaches.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Critical Care Medicine
Chung-Ting Chen, Jin-Wei Lin, Cheng-Hsueh Wu, Raymond Nien-Chen Kuo, Chia-Hui Shih, Peter Chuanyi Hou, David Hung-Tsang Yen, Chorng-Kuang How
Summary: In this retrospective observational cohort study conducted in two large academic medical networks in the United States, a risk score known as SLANT score was developed to evaluate the risk of poor neurologic outcomes at discharge for out-of-hospital cardiac arrest survivors after targeted temperature management. Patients were categorized into three risk groups (moderate, high, and very high) based on their SLANT scores and the ability of the risk score to predict outcomes was significant. This study suggests that the SLANT score model is a useful tool for assessing the risk of poor neurologic outcomes and in-hospital mortality in patients after out-of-hospital cardiac arrest.
CRITICAL CARE MEDICINE
(2022)
Article
Critical Care Medicine
Niklas Nielsen, Hans Friberg
Summary: For the past 20 years, induced hypothermia and targeted temperature management have been recommended to mitigate brain injury and increase survival after cardiac arrest. However, larger clinical trials have suggested little or no effect of this intervention, leading to new recommendations from the International Liaison Committee on Resuscitation. This article discusses the evolution of temperature management for cardiac arrest patients and the potential paths forward in this field.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2023)
Review
Medicine, General & Internal
Ayman Elbadawi, Ramy Sedhom, Basarat Baig, Ingy Mahana, Ravi Thakker, Mohamed Gad, Mennallah Eid, Ajith Nair, Waleed Kayani, Ali Denktas, Islam Y. Elgendy, Hani Jneid
Summary: A recent randomized clinical trial has questioned the role of targeted hypothermia in coma patients after cardiac arrest. The study found no significant difference in survival or neurological outcomes between targeted hypothermia and normothermia in these patients. Further research is needed to clarify the value of targeted hypothermia compared with targeted normothermia.
AMERICAN JOURNAL OF MEDICINE
(2022)
Article
Critical Care Medicine
Kevin Roedl, Sebastian Wolfrum, Guido Michels, Martin Pin, Gerold Soeffker, Uwe Janssens, Stefan Kluge
Summary: This survey investigated the current clinical practice of temperature control after out of hospital cardiac arrest (OHCA). It found that 72% of physicians used hypothermic target temperature control, while 28% used normothermic target temperature control. Additionally, 37% of respondents changed their clinical practice after recent guideline updates.
Article
Critical Care Medicine
Toishi Sharma, Jordan Kunkes, David O'Sullivan, Antonio B. Fernandez
Summary: Patients undergoing Targeted Temperature Management (TTM) after cardiac arrest have a statistically higher incidence of venous thromboembolism (VTE) and deep vein thrombosis (DVT) compared to patients with Acute Respiratory Distress Syndrome (ARDS). This risk is independent of age, gender, race, or length of stay.
Review
Emergency Medicine
Lukasz Szarpak, Krzysztof J. Filipiak, Lauretta Mosteller, Milosz Jaguszewski, Jacek Smereka, Kurt Ruetzler, Sanchit Ahuja, Jerzy R. Ladny
Summary: This study found that pre-hospital therapeutic hypothermia does not improve survival or neurological outcomes in patients with pre-hospital cardiac arrest. While there may be an increase in pulmonary edema and rearrest rates, the overall effect is not significant.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Article
Emergency Medicine
Talal S. Alnabelsi, Sarah P. Faulkner, Matthew Cook, Kalen Freeman, Julie Shelton, Marc Paranzino, Sethabhisha Nerusu, Susan S. Smyth, Vedant A. Gupta
Summary: Targeted temperature management is crucial for comatose patients after cardiac arrest. The study found that using antipyretics alone may not be sufficient to maintain target temperatures. However, antipyretics could be used as an initial strategy in conjunction with more aggressive cooling techniques.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2021)
Article
Medicine, General & Internal
Sang-Min Kim, Chun-Song Youn, Gun-Tak Lee, Tae-Gun Shin, June-Sung Kim, Youn-Jung Kim, Won-Young Kim
Summary: CMR imaging was evaluated for identifying unknown causes of cardiac arrest in OHCA survivors treated with TTM. Among 40 patients included in the study, CMR imaging showed normal results in 23 patients, non-diagnostic in 12, and abnormal in 5. Further large-scale studies will be needed to confirm these findings.
JOURNAL OF CLINICAL MEDICINE
(2021)
