From the Guidelines
Post-cardiac arrest targeted temperature management (TTM) is recommended for patients who remain comatose after return of spontaneous circulation (ROSC) 1.
Criteria for TTM
The criteria for TTM include:
- Comatose adult patients with ROSC after cardiac arrest 1
- Target temperature between 32°C and 36°C 1
- Maintaining the target temperature for at least 24 hours 1
- Using surface or intravascular cooling methods to achieve the target temperature 1
- Actively preventing fever by targeting a temperature ≤37.5°C 1
- Avoiding routine prehospital cooling with rapid infusion of large volumes of cold intravenous fluid immediately after ROSC 1
Implementation of TTM
TTM should be implemented as follows:
- Selecting and maintaining a constant target temperature between 32°C and 36°C 1
- Using a temperature control device that includes a feedback system based on continuous temperature monitoring to maintain the target temperature 1
- Considering the use of sedation and neuromuscular blockade to minimize shivering 1
- Rewarming at a rate of 0.25-0.5°C per hour to avoid rapid changes in cerebral blood flow 1 It is essential to note that the optimal duration for TTM and the specific target temperature within the recommended range may vary depending on individual patient factors and the clinical context 1.
From the Research
Criteria for Post-Cardiac Arrest Targeted Temperature Management (TTM)
The criteria for post-cardiac arrest targeted temperature management (TTM) include:
- Selecting and maintaining a constant target temperature between 32 and 36 °C for comatose patients after cardiac arrest 2
- Maintaining the target temperature for at least 24 hours 3, 2, 4
- Avoiding rebound hyperthermia, defined as a temperature above 37.7 °C, and treating fever for at least 72 hours after return of spontaneous circulation (ROSC) in persistently comatose patients 3
- Considering the optimal target temperature based on the severity of the patient's condition 5
- Using a combination of initial prediction models, biomarkers, neuroimaging, and electrophysiological methods for early neuro-prognostication after TTM 4, 5
Patient Selection for TTM
Patients who should be considered for TTM include:
- Comatose adult patients after cardiac arrest, regardless of the initial presenting rhythm 2
- Patients who remain unresponsive following ROSC after either out-of-hospital cardiac arrest or in-hospital cardiac arrest 3
- Patients with post-cardiac arrest syndrome due to cardiac etiology, with the target core temperature and cooling duration selected according to the time interval from collapse to ROSC 6
Implementation of TTM
The implementation of TTM should involve:
- Early induction of TTM as soon as possible after ROSC is achieved and airway, breathing, and circulation are stabilized 2
- Maintenance of the target temperature for at least 24 hours, with slow rewarming utilizing endovascular methods 4
- Protocolized post-arrest care consisting of cardiovascular optimization, ventilation and oxygenation adjustment, coronary revascularization, TTM, and control of seizures and blood sugar 5