From the Research
A TTM plan for post-cardiac arrest patients should include selecting and maintaining a constant target temperature between 32 and 36 °C for at least 24 hours, as soon as possible after return of spontaneous circulation is achieved and airway, breathing, and circulation are stabilized 1.
Key Considerations
- The decision to opt for targeted hypothermia versus targeted normothermia should be made on a case-by-case basis, considering the individual patient's condition and the potential benefits and risks of each approach 1.
- Any survivor of cardiac arrest who is comatose should be considered as a candidate for TTM, regardless of the initial presenting rhythm 1.
- Current guidelines recommend controlling temperature to prevent hyperthermia, as fever or hyperthermia during the first few days after cardiac arrest is associated with worse outcomes 2.
Implementation
- Begin with immediate cooling using ice packs, cold IV fluids, and cooling devices.
- Maintain target temperature using specialized equipment like endovascular catheters or surface cooling pads.
- Monitor core temperature continuously via esophageal, bladder, or pulmonary artery probes.
- Provide sedation and neuromuscular blockade to prevent shivering.
- Manage complications including electrolyte abnormalities, coagulopathy, and infection risk.
Temperature Management
- The comparative benefit of lower (32-34 °C) versus higher (36 °C) temperatures remains unknown, and further research may help elucidate this 1.
- Higher temperatures can lead to secondary brain injury by increasing seizures, brain edema, and metabolic demand 2.
- Clinical temperature management should address the physiology of heat balance, and core temperature reflects the heat content of the head and torso 2.