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Updated: Jan 14, 2026
Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management
Published on: November 21, 2017
Earlier Initiation of Targeted Temperature Management for Out-of-Hospital Cardiac Arrest Patients: A Quality
Amna Aijaz1,2,3, Maria Riasat1,2,3, Yousuf Aijaz Wahid1,2,3
1Author Affiliations: Department of Cardiology (Dr Aijaz), Department of Pulmonary and Critical Care Medicine (Dr Farooq), University of Texas Health Science Center at Houston, Houston Texas; Department of Cardiology (Dr Riasat), Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, New York, New York; Aga Khan University (Dr Wahid), Medical College, Karachi, Pakistan; Department of Medicine (Dr Miyakawa), Division of Pulmonary and Critical Care Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, and Department of Medicine (Dr Lee), Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Background:
Targeted temperature management (TTM) is widely used for patients presenting with cardiac arrest for its neuroprotective effects and has been shown to improve neurological outcomes and survival. In keeping with the adage "time is brain" and per prior retrospective studies supporting earlier initiation of TTM, we conducted a quality improvement project to improve Door to TTM initiation time (DTT).
Objectives:
Our primary aim was to reduce DTT in patients who presented with Out-of-Hospital Cardiac Arrest (OHCA). Our secondary aims were to determine the factors for the delay in initiation of TTM, determine the knowledge and perspectives regarding TTM, address gaps in knowledge, and identify system issues to reduce time to TTM initiation.
Methods:
To assess knowledge and perspectives about TTM and any delays in initiation, a baseline survey of clinicians involved in the direct care of OHCA patients was conducted. A series of interventions followed after which a post-intervention survey was conducted.
Results:
Post-intervention there was an increased proportion of participants who had read the TTM protocol (but not significantly different) (69.1% vs 84.6%, P = .07) and a decreased proportion believed that TTM was initiated at a satisfactory time on eligible patients (54.4% vs 30.8%, P = .02). The mean DTT decreased sequentially from a baseline of 5.3 hours to 1 hour, post-interventions. The mean DTT among non-survivors (n = 21) was 5.51 (95% CL: 3.86-7.16) hours and the mean DTT among survivors (n = 6) was 2.58 (95% CL: 0.98-4.19) hours with a difference that was not statistically significant for a 5% level of significance at a P-value of .068.
Conclusion:
Our QI project interventions were successful in lowering the DTT for OHCA patients. Larger and longer studies are needed to study associations between TTM initiation time, and neurological and survival outcomes.
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