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Open Access 17-12-2022 | Temperature Management | Review

Targeted Temperature Management in Cardiac Arrest: An Updated Narrative Review

Authors: Agastya D. Belur, Yub Raj Sedhai, Alexander G. Truesdell, Ashish K. Khanna, Joseph D. Mishkin, P. Matthew Belford, David X. Zhao, Saraschandra Vallabhajosyula

Published in: Cardiology and Therapy | Issue 1/2023

Abstract

The established benefits of cooling along with development of sophisticated methods to safely and precisely induce, maintain, monitor, and reverse hypothermia have led to the development of targeted temperature management (TTM). Early trials in human subjects showed that hypothermia conferred better neurological outcomes when compared to normothermia among survivors of cardiac arrest, leading to guidelines recommending targeted hypothermia in this patient population. Multiple studies have sought to explore and compare the benefit of hypothermia in various subgroups of patients, such as survivors of out-of-hospital cardiac arrest versus in-hospital cardiac arrest, and survivors of an initial shockable versus non-shockable rhythm. Larger and more recent trials have shown no statistically significant difference in neurological outcomes between patients with targeted hypothermia and targeted normothermia; further, aggressive cooling is associated with a higher incidence of multiple systemic complications. Based on this data, temporal trends have leaned towards using a lenient temperature target in more recent times. Current guidelines recommend selecting and maintaining a constant target temperature between 32 and 36 °C for those patients in whom TTM is used (strong recommendation, moderate-quality evidence), as soon as possible after return of spontaneous circulation is achieved and airway, breathing (including mechanical ventilation), and circulation are stabilized. The comparative benefit of lower (32–34 °C) versus higher (36 °C) temperatures remains unknown, and further research may help elucidate this. Any survivor of cardiac arrest who is comatose (defined as unarousable unresponsiveness to external stimuli) should be considered as a candidate for TTM regardless of the initial presenting rhythm, and the decision to opt for targeted hypothermia versus targeted normothermia should be made on a case-by-case basis.

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Title: Targeted Temperature Management in Cardiac Arrest: An Updated Narrative Review
Authors: Agastya D. Belur
Yub Raj Sedhai
Alexander G. Truesdell
Ashish K. Khanna
Joseph D. Mishkin
P. Matthew Belford
David X. Zhao
Saraschandra Vallabhajosyula
Publication date: 17-12-2022
Publisher: Springer Healthcare
Keyword: Temperature Management
Published in: Cardiology and Therapy / Issue 1/2023
Print ISSN: 2193-8261
Electronic ISSN: 2193-6544
DOI: https://doi.org/10.1007/s40119-022-00292-4

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Targeted Temperature Management in Cardiac Arrest: An Updated Narrative Review

Abstract

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