Targeted Temperature Management for Treatment of Cardiac Arrest

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.