TARGETED TEMPERATURE MANAGEMENT IN

OUT OF HOSPITAL CARDIAC ARREST

Lewis Macken

ICU

RNS

Post-cardiac arrest syndrome with coma.

TTM ?

Critical Care Med 2011

How does TTM work?

2012

RR 1.55RR 1.35

Available evidence

77 + 275 = 352

2010

Thrombolysis in AMI trials

330C for 12 hours

77 patients included

1ary outcome = survival to hospital discharge

home or rehabilitation facility = ‘good’ outcome

OR 5, 1.4-18.7

32-340C for 24 hours

275 patients

HACA

RR 1.4 RR 0.75

1.No active temperature control

2.Early stopping

3.8% of OOHCA

OR 2.2

“milder levels of hypothermia might have similar protective effects”

Dose of hypothermia ?

77 for 12 hours @ 33oC 275 for 24 hours @ 32-34oC

Target temperature management

after out-of-hospital cardiac arrest

The TTM-trial

TTM Trial

Temperature profile

HACA-trial 2002