Integrated postcardiac arrest care is now the 5th link in the aha adult chain of survival. The term targeted temperature management ttm has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each. The arctic sun system consists of the control module and singleuse energy transfer pads. Primary outcome was neurologically intact survival to discharge. Targeted temperature management for cardiac arrest with. Targeted temperature management has replaced therapeutic hypothermia to encompass the management of temperature control. The publication of the targeted temperature management ttm trial, which reported that cooling to 33 c. Clinical applications of targeted temperature management. Not so effective in maintaining target temperature resuscitation 2007 73, 4653 surface cooling systems circulating cold fluid or cold air through blanketspads wrapped around the patient easy to apply and rapid initiation of treatment maintenance of temperature may be difficult shivering is more common. Conference location the postarrest care and targeted temperature management a practical training course for health care providerswill be held fridaysaturday, june 2122, 2019 in the law auditorium at the jordan medical education center located on the 5th. Moderate therapeutic hypothermia is recommended in patients with persistent coma after resuscitated outofhospital cardiac arrest in order to improve neurologic outcomes.
Targeted temperature management ttm preserves cerebral function in patients resuscitated after cardiac arrest. Clinicians have been treating patient temperature for centuries as it is widely recognized that temperature may contribute to the maintenance of normal physiology and may affect the processes that lead to recovery after an illness. Advanced airway including biad in place with no purposeful response to verbal commands. To reduce unfavorable outcome in tbi patients, many researches have made much efforts for the innovation of tbi treatment. Targeted temperature management is neuroprotective in comatosed post cardiac arrest patients.
The primary outcome was allcause mortality through the end of the trial. Division of neurology, department of medicine, faculty of medicine, thammasat. Targeted temperature management after intracerebral. Ttm may be used to prevent fever, to maintain normothermia, or to lower core temperature. A guideline to direct evidencebased care to post cardiac arrest patients who remain comatose after return of spontaneous circulation. The level of targeted temperature may differ according to the situation. Pdf abstract targeted temperature management ttm is a complex intervention used with the aim of minimizing postanoxic injury and. Nevertheless, the scientific community has raised concerns about the level of evidence supporting this recommendation. In international guidelines, targeted temperature management. Therapeutic hypothermia and temperature management. Postanoxic brain damage is the most dramatic complication of cardiac arrest 1. Jan 06, 2020 targeted temperature management ttm is a complex intervention used with the aim of minimizing postanoxic injury and improving neurological outcome after cardiac arrest. Importance international resuscitation guidelines recommend targeted temperature management ttm at 33c to 36c in unconscious patients with outofhospital cardiac arrest for at least 24 hours, but the optimal duration of ttm is uncertain. Target temperature of 36 c is recommended only if patient is at high risk for bleeding related to.
Targeted temperature management in traumatic brain injury. Review the mechanisms of injury after cardiac arrest. The term targeted temperature management ttm has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. We present the case of a 59yearold gentleman with a history of nonmetastatic tonsillar malignancy and radiation chondronecrosis, who underwent targeted temperature management ttm in a sequential manner. Uphs post cardiac arrest targeted temperature management ttm. Targeted temperature management in pediatric neurocritical care. Targeted temperature management ttm previously known as therapeutic hypothermia or protective hypothermia is an active treatment that tries to achieve and maintain a specific body temperature in a person for a specific duration of time in an effort to improve health outcomes during recovery after a period of stopped blood flow to the brain. Postanoxic brain damage is the most dramatic complication of cardiac arrest. Targeted temperature management in pediatric neurocritical. The targeted temperature management after intracerebral hemorrhage trial is a prospective, single. The term targeted temperature management ttm has emerged as the most appropriate referring to interventions used to reach and maintain a specific level temperature for each individual. Target temperature of 33 c range 32 34 c is recommended, and should be achieved within 4 hours of obtaining return of spontaneous circulation rosc, and maintained for at least 24 hours from time the target temperature is achieved. In fact, temperature management was performed for 12 hours longer in the 33c group, due to additional time required for rewarming. Cocchi md assistant professor, harvard medical school.
This occurs through decreasing cellular metabolism and oxygen demand, reducing production of excitatory neurotransmitters, minimizing disruption of. Targeted temperature management ttm has been investigated experimentally and used clinically for over 100 years. Targeted temperature management initiation after out. Publication charges for this supplement were funded by cr bard. Therapeutic hypothermia and temperature management ahead of. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services and structure, and clinical information. But its effectiveness in patients with nonshockable rhythm still remains unclear. We performed an openlabel, randomized, controlled trial comparing moderate therapeutic hypothermia 33c during the first 24 hours with targeted normothermia 37c in patients with coma who. Jan 22, 2014 the targeted temperature management after intracerebral hemorrhage trial is a prospective, single. Targeted temperature management ttm, previously known as therapeutic. Targeted temperature management ttm is a complex intervention used with the aim of minimizing postanoxic injury and improving neurological outcome after cardiac arrest.
Canadian guidelines for the use of targeted temperature. Interpreting the results of the targeted temperature. Erc resuscitation guidelines recommend that targeted temperature management should be implemented in all adult coma patients with return of spontaneous circulation. Original article from the new england journal of medicine targeted temperature management at 33c versus 36c after cardiac arrest. Targeted temperature management als procedure ap10. Review how targeted temperature management ttm mitigates injuries after cardiac arrest. Unconscious survivors of outofhospital cardiac arrest have a high risk of death or poor neurologic function. In an international trial, we randomly assigned 950 unconscious adults after outofhospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33c or 36c. Targeted temperature management encompasses a range of clinical interventions to regulate systemic temperature, and includes both induction of varying degrees of hypothermia and fever prevention targeted normothermia. Targeted temperature management ttm patient body temperature is a measured and controlled vital sign. The administration of targeted temperature management ttm is considered standard of care in the treatment of comatose cardiac arrest survivors, particularly those with out.
Therapeutic hypothermia and temperature management ahead. Targeted temperature management has also been shown to abort seizures in animal models. The postarrest care and targeted temperature management a practical training course for health care providerswill be held fridaysaturday, june 2122, 2019 in the law auditorium at the jordan medical education center located on the 5th. Targeted temperature management napa county, california. Targeted temperature management after cardiac arrest. Pdf high quality targeted temperature management ttm after.
There is large variability in the devices used to achieve cooling and in protocols e. Targeted temperature management ttm 2014 meeting abstracts. Variability in postarrest targeted temperature management practice. Use of targeted temperature management post cardiac arrest. The initial rationale for the clinical application of ttm, historically referred to as therapeutic hypothermia, was to decrease the metabolic rate, allowing the injured brain time to heal. Bmc emergency medicine targeted temperature management. In international guidelines, targeted temperature management ttm is the only neuroprotective intervention currently recommended after outofhospital cardiac arrest ohca. Targeted temperature management therapeutic hypothermia in. Post cardiac arrest targeted temperature page 2 of 10 management ttm disclaimer. Saving the neurons mary ann bautista, dnp, rn, agcnsbc, agacnpbc disclosure financial support. Not so effective in maintaining target temperature resuscitation 2007 73, 4653 surface cooling systems circulating cold fluid or cold air through blanketspads wrapped around the patient easy to apply and rapid initiation of treatment maintenance of temperature may be difficult.
Targeted temperature management an overview sciencedirect. Return of spontaneous circulation not related to blunt penetrating trauma or hemorrhage with ventricular fibrillation tachycardia and. We wanted to investigate whether the introduction of targeted temperature management to clinical practice had increased the survival of cardiac arrest patients at haukeland university hospital, norway. Targeted temperature management has three main phases which are interchangeable depending on the target temperature set. Interaction effects between targeted temperature management and hypertension on survival outcomes after outofhospital cardiac arrest. Targeted temperature management following cardiac arrest. This can be achieved through various methods and targeted temperatures. Adult cardiac protocol section pearls criteria for targeted temperature mangement. The first time the patient underwent therapeutic cooling occurred after he developed a respiratory arrest followed by a cardiac arrest and prolonged hypoxemia after a diagnostic. Ttm may be used to prevent fever, to maintain normothermia, or. Eujene jung, sun young lee, jeong ho park, young sun ro, ki jeong hong, kyoung jun song, hyun ho ryu, and.
Traumatic brain injury tbi is recognized as the significant cause of mortality and morbidity in the world. Temperature management after cardiac arrest circulation. Targeted temperature management in critical care neurology. Topics of focus for postcardiac arrest care include ttm targeted temperature management, hemodynamic and ventilation optimization, immediate coronary reperfusion with pci percutaneous coronary intervention, glycemic control, neurologic care and. Ihca, and postcardiac arrest targeted temperature management ttm part. This guideline should be used in conjunction with the targeted temperature management ttm orderset in penn chart. Targeted temperature management in critical care neurology supaporn konmun sornsawan sriratanaporn sorapat kittiudom sombat muengtaweepongsa, m.
In patients with ohca, if the presenting rhythm is either vf or vt these patients should be cooled as early as possible for at least 2448 h. Targeted temperature management at 33 versus 36 degrees. The arctic sun 5000 temperature management system enables. Targeted temperature management after cardiac arrest postanoxic brain damage after cardiac arrest is a complex condition that is managed through targeted temperature management ttm as it is currently the only neuroprotective intervention recommended after outofhospital cardiac arrest ohca. Targeted temperature management ttm is a strategy used by critical care nurses to mitigate negative effects of outofhospital cardiac arrest ohca. In an international trial, we randomly assigned 950 unconscious adults after outofhospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33c or. The new touch screen interface guides clinicians to initiate treatment with a few steps. Our primary exposure was targeted temperature management goal temperature, which was changed from 33c to 36c in april of 2014 at the study hospital. Mechanism of benefit, clinical use and recommendations, and relevant formal guidelines bassel ericsoussi, md fellow, pulmonary and critical care medicine university of illinois medical center at chicago 2.
Pdf targeted temperature management at 33c versus 36c. A targeted temperature is set to provide neuroprotection and better. Targeted temperature management therapeutic hypothermia. Jul 25, 2017 conclusions and relevance in unconscious survivors from outofhospital cardiac arrest admitted to the icu, targeted temperature management at 33c for 48 hours did not significantly improve 6month neurologic outcome compared with targeted temperature management at 33c for 24 hours. With the results from several basic and clinical studies, targeted temperature management ttm including therapeutic hypothermia th have been.
The temperature feedback from the patient is supplied to the control module using a bladder thermistor bard criticore catheter. Randomization and blinding at each center, eligible patients were randomly assigned in a 1. Adults with nontraumatic outofhospital cardiac arrest who received targeted temperature management. Targeted temperature management in subarachnoid haemorrhage. Targeted temperature management plays a key role in the contemporary management of critically ill neonates. Original article from the new england journal of medicine targeted temperature management for cardiac arrest with nonshockable rhythm. However, the study may have had limited power to detect. Return of spontaneous circulation not related to blunt penetrating trauma or hemorrhage with ventricular fibrillation tachycardia and nonshockable arrhythmias. Targeted temperature management for 48 vs 24 hours and. There is large variability in the devices used to achieve cooling and in protocols. Francois payen2,karim asehnoune14,gerard audibert9,astrid botte15,olivier brissaud16. Targeted temperature management at 33c versus 36c after. Post cardiac arrest targeted temperature management ttm.