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Variability in Postarrest Targeted Temperature Management Practice: Implications of the 2015 Guidelines
Marion Leary1,2, Audrey L Blewer1,3, Gail Delfin1
11 Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania.
Therapeutic Hypothermia and Temperature Management
|December 9, 2015
Summary
Targeted temperature management (TTM) guidelines now recommend a temperature range of 32-36°C for post-cardiac arrest care. However, the impact of this temperature variability on patient outcomes remains unclear.
Area of Science:
- Cardiology
- Neurology
- Emergency Medicine
Background:
- Therapeutic hypothermia (TH) at 32-34°C improved outcomes post-cardiac arrest since 2002.
- A 2013 trial showed similar outcomes for targeted temperature management (TTM) between 33°C and 36°C.
- Pre-2015, significant variability in TTM protocols existed across US hospitals.
Purpose of the Study:
- To analyze the evolution of TTM guidelines for post-cardiac arrest care.
- To investigate the variability in TTM protocols and its potential impact on patient outcomes.
Main Methods:
- Review of randomized controlled trials and clinical practice guidelines.
- Analysis of TTM protocol implementation across US healthcare institutions.
Main Results:
- Initial TH protocols focused on 32-34°C, later expanded by TTM trials.
- The 2015 American Heart Association (AHA) Guidelines recommend a broader TTM range of 32-36°C.
- Significant protocol variability in TTM implementation persists.
Conclusions:
- Current AHA guidelines permit a wider temperature range for TTM post-cardiac arrest.
- The clinical significance of TTM temperature variability on patient survival and neurologic recovery requires further investigation.
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