Targeted Temperature Management for Treatment of Cardiac Arrest
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(2020) 22:39
Arrhythmia (R Kabra, Section Editor)
Targeted Temperature Management for Treatment of Cardiac Arrest Tyler P. Rasmussen, MD, PhD1,2,* T. C. Bullis, MD2 S. Girotra, MD, SM1,2 Address *,1 Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Dr. E 318-5 GH, Iowa City, IA, 52242, USA Email: [email protected] 2 Depatment of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Arrhythmia Keywords Cardiac arrest I Therapeutic hypothermia I Targeted temperature management Abbreviations IHCA In-hospital cardiac arrest OHCA Out-of-hospital cardiac arrest PEA Pulseless electrical ac_ _ tivity VT Ventricular tachycardia
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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.
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Curr Treat Options Cardio Med
(2020) 22:39
Introduction More than 650,000 adults experience a cardiac arrest each year in the USA [1]. Although survival for both in-hospital and out-of-hospital cardiac arrests has improved in recent years [2, 3], overall survival continues to remain low. The mean survival for out-of-hospital cardiac arrest (OHCA) is nearly 10% [4], while mean survival for in-hospital arrest (IHCA) is approximately 25% [5, 6]. Among patients who survive, there is a substantial risk of neurological disability and poor quality of life [7]. Efforts for improving resuscitation care quality have largely focused on improving the timeliness and quality of acute resuscitation (e.g.,
bystander cardiopulmonary resuscitation, timely defibrillation). However, there is overwhelming evidence that neurological injury conti
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