ICU · Neurocritical Care

Targeted temperature management after cardiac arrest

Also known as Targeted temperature management (TTM) · Therapeutic hypothermia · TTM trial · Post-cardiac arrest care

Targeted temperature management (TTM) after cardiac arrest aims to reduce neurological injury from post-cardiac arrest brain ischaemia-reperfusion. HACA and Bernard (NEJM 2002): 32-34°C for 24h (or 33°C for 12h) improved neurological outcome after VF arrest. TTM trial (NEJM 2013): 33°C vs 36°C showed no difference in outcomes (both acceptable). TTM2 (NEJM 2021): hypothermia at 33°C offered no advantage over normothermia with early fever treatment (triggered at 37.8°C). HYPERION (NEJM 2019): 33°C for 24h improved 90-day neurological outcome in non-shockable rhythm arrest. Indications: comatose adult patients after OHCA with shockable (VF/VT — strongest evidence) or non-shockable rhythm, and after IHCA. Method: surface or intravascular cooling. Target: 32-36°C for 24h, then controlled rewarming (0.5°C/h in the TTM trial protocol) to 37°C. Maintain normothermia (under 37.5°C) for 72h. Avoid fever (worsens outcomes — odds of unfavourable outcome rise about 2.3-fold per degree above 37°C). Shivering must be controlled (skin counterwarming, magnesium, sedation, paralysis).