Targeted Temperature Management for Treatment of Cardiac Arrest

Overview

Journal Curr Treat Options Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2020 Oct 19

PMID 33071538

Citations 7

Authors

Tyler P Rasmussen

T C Bullis

S Girotra

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: Cardiac arrest is a common condition associated with high mortality and a substantial risk of neurological injury among survivors. Targeted temperature management (TTM) is the only strategy shown to reduce the risk of neurologic disability cardiac arrest patients. In this article, we provide a comprehensive review of TTM with an emphasis on recent trials.

Recent Findings: After early studies demonstrating the benefit of TTM in out-of-hospital cardiac arrest due to a shockable rhythm, newer studies have extended the benefit of TTM to patients with a nonshockable rhythm and in-hospital cardiac arrest. A target temperature of 33 °C was not superior to 36 °C, suggesting that a lenient targeted temperature may be appropriate especially for patients unable to tolerate lower temperatures. Although early initiation of TTM appears to be beneficial, the benefit of prehospital cooling has not been shown and use of intravenous cold saline in the prehospital setting may be harmful.

Summary: There is substantial risk of neurological injury in cardiac arrest survivors who remain comatose. TTM is an effective treatment that can lower the risk of neurological disability in such patients and ideally delivered as part of a comprehensive, goal-directed post-resuscitation management by a multidisciplinary team in a tertiary medical center.

Citing Articles

Unveiling Breakthroughs in Post-resuscitation Supportive Care for Out-of-Hospital Cardiac Arrest Survivors: A Narrative Review.

Jagarlamudi N, Soni K, Ahmed S, Makkapati N, Janarthanam S, Vallejo-Zambrano C Cureus. 2023; 15(9):e44783.

PMID: 37809191 PMC: 10558054. DOI: 10.7759/cureus.44783.

Effectiveness of Induced Hypothermia on the Prognosis of Post-cardiac Arrest Patients: A Scoping Literature Review.

Rohit R, Tibrewal C, Modi N, Bajoria P, Dave P, Gandhi S Cureus. 2023; 15(8):e43064.

PMID: 37680442 PMC: 10481631. DOI: 10.7759/cureus.43064.

Temperature Control After Cardiac Arrest: A Narrative Review.

Fernandez Hernandez S, Barlow B, Pertsovskaya V, Maciel C Adv Ther. 2023; 40(5):2097-2115.

PMID: 36964887 PMC: 10129937. DOI: 10.1007/s12325-023-02494-1.

Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States.

Olanipekun T, Abe T, Chris-Olaiya A, Effoe V, Bhardwaj A, Harrison M Crit Care Explor. 2023; 5(1):e0838.

PMID: 36699243 PMC: 9831170. DOI: 10.1097/CCE.0000000000000838.

Targeted Temperature Management in Cardiac Arrest: An Updated Narrative Review.

Belur A, Sedhai Y, Truesdell A, Khanna A, Mishkin J, Belford P Cardiol Ther. 2022; 12(1):65-84.

PMID: 36527676 PMC: 9986171. DOI: 10.1007/s40119-022-00292-4.

References

Bernard S, Gray T, Buist M, Jones B, Silvester W, Gutteridge G . Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; 346(8):557-63. DOI: 10.1056/NEJMoa003289. View

Martin L, Brambrink A, Kirsch J, Sieber F, Portera-Cailliau C . Neurodegeneration in excitotoxicity, global cerebral ischemia, and target deprivation: A perspective on the contributions of apoptosis and necrosis. Brain Res Bull. 1998; 46(4):281-309. DOI: 10.1016/s0361-9230(98)00024-0. View

Donnino M, Rittenberger J, Gaieski D, Cocchi M, Giberson B, Peberdy M . The development and implementation of cardiac arrest centers. Resuscitation. 2011; 82(8):974-8. DOI: 10.1016/j.resuscitation.2011.03.021. View

Girotra S, Nallamothu B, Spertus J, Li Y, Krumholz H, Chan P . Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012; 367(20):1912-20. PMC: 3517894. DOI: 10.1056/NEJMoa1109148. View

Moler F, Silverstein F, Holubkov R, Slomine B, Christensen J, Nadkarni V . Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children. N Engl J Med. 2017; 376(4):318-329. PMC: 5310766. DOI: 10.1056/NEJMoa1610493. View

Benjamin E, Muntner P, Alonso A, Bittencourt M, Callaway C, Carson A . Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019; 139(10):e56-e528. DOI: 10.1161/CIR.0000000000000659. View

Pulsinelli W, Waldman S, Rawlinson D, Plum F . Moderate hyperglycemia augments ischemic brain damage: a neuropathologic study in the rat. Neurology. 1982; 32(11):1239-46. DOI: 10.1212/wnl.32.11.1239. View

Yenari M, Han H . Neuroprotective mechanisms of hypothermia in brain ischaemia. Nat Rev Neurosci. 2012; 13(4):267-78. DOI: 10.1038/nrn3174. View

Nordberg P, Taccone F, Truhlar A, Forsberg S, Hollenberg J, Jonsson M . Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital Cardiac Arrest: The PRINCESS Randomized Clinical Trial. JAMA. 2019; 321(17):1677-1685. PMC: 6506882. DOI: 10.1001/jama.2019.4149. View

10.

Rosol Z, Miranda D, Sandoval Y, Bart B, Smith S, Goldsmith S . The effect of targeted temperature management on QT and corrected QT intervals in patients with cardiac arrest. J Crit Care. 2017; 39:182-184. DOI: 10.1016/j.jcrc.2017.02.030. View

11.

Benjamin E, Blaha M, Chiuve S, Cushman M, Das S, Deo R . Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017; 135(10):e146-e603. PMC: 5408160. DOI: 10.1161/CIR.0000000000000485. View

12.

Benson D, WILLIAMS Jr G, SPENCER F, Yates A . The use of hypothermia after cardiac arrest. Anesth Analg. 1959; 38:423-8. View

13.

Neumar R, Nolan J, Adrie C, Aibiki M, Berg R, Bottiger B . Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on.... Circulation. 2008; 118(23):2452-83. DOI: 10.1161/CIRCULATIONAHA.108.190652. View

14.

Glover G, Thomas R, Vamvakas G, Al-Subaie N, Cranshaw J, Walden A . Intravascular versus surface cooling for targeted temperature management after out-of-hospital cardiac arrest - an analysis of the TTM trial data. Crit Care. 2016; 20(1):381. PMC: 5124238. DOI: 10.1186/s13054-016-1552-6. View

15.

Kim F, Nichol G, Maynard C, Hallstrom A, Kudenchuk P, Rea T . Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA. 2013; 311(1):45-52. DOI: 10.1001/jama.2013.282173. View

16.

Bradley S, Liu W, McNally B, Vellano K, Henry T, Mooney M . Temporal Trends in the Use of Therapeutic Hypothermia for Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2019; 1(7):e184511. PMC: 6324404. DOI: 10.1001/jamanetworkopen.2018.4511. View

17.

Chan P, Berg R, Tang Y, Curtis L, Spertus J . Association Between Therapeutic Hypothermia and Survival After In-Hospital Cardiac Arrest. JAMA. 2016; 316(13):1375-1382. PMC: 5486217. DOI: 10.1001/jama.2016.14380. View

18.

Tonna J . Postresuscitation Management and Survival After Cardiac Arrest-The Whole Package. JAMA Netw Open. 2020; 3(7):e2010921. PMC: 7694892. DOI: 10.1001/jamanetworkopen.2020.10921. View

19.

Sendelbach S, Hearst M, Johnson P, Unger B, Mooney M . Effects of variation in temperature management on cerebral performance category scores in patients who received therapeutic hypothermia post cardiac arrest. Resuscitation. 2012; 83(7):829-34. DOI: 10.1016/j.resuscitation.2011.12.026. View

20.

Neumar R . Molecular mechanisms of ischemic neuronal injury. Ann Emerg Med. 2000; 36(5):483-506. DOI: 10.1067/mem.2000.110995. View