TTM Connection #4

TTM Connection



TTM CONNECTION—Where Science Meets Education

Therapeutic Hypothermia and Temperature Management

Dear Clinicians:

Happy New Year! In 2014, we look forward to providing information and  updates from the scientific community. We will also be introducing a website in the upcoming months.

Health Professionals
The Science Center is focused on Targeted Temperature Management (TTM) by advancing the delivery of health care education. This scientific platform will cover all aspects of therapeutic hypothermia and controlled normothermia specifically in disease states such as cardiac arrest, spinal cord injury, traumatic brain injury, stroke, intracerebral hemorrhage, SAH, and burns.

Scientific Advancements and Research
Discover and learn about Targeted Temperature Management. We will provide resources and documented findings as well as clinical studies, review articles, biological discoveries and contributions from scientists throughout the globe.

Targeted Temperature Events
Upcoming dates for scholarly lectures, webinars, seminars and educational events throughout the globe will be published in the newsletter. Please review the event calendar of all upcoming TTM Events below.

The Audio and Video Library
The Center better seeks to understand and disseminate the protective mechanism of TTM, both therapeutic  hypothermia and controlled normothermia, and to improve awareness by providing a unified collection of simple and easily accessible audio and video library of academic information. The TTM Connection contains links to some of these videos below.

Highest Regards,
Dr. Jennifer Williams and Phil Abenojar RN, BSN
(Medical Science Liaisons)

Global Science Center For TTM

Updates from the Field

NIH project to assess new drug-induced hypothermia
Lawrence Katz, MD, at the University of North Carolina at Chapel Hill, will investigate a new approach to therapeutic hypothermia, a drug called HBN-1, which induces cooling by targeting the brain region that controls body temperature. Resetting the body’s temperature set point with the drug will enable therapeutic hypothermia without paralysis, sedation, ancillary equipment, or need for mechanical ventilation. The body will reduce metabolism, block shivering, and increase heat loss through peripheral vasodilatation and sweating. If the drug becomes commercially available, paramedics could more quickly and safely start the cooling process with an intravenous injection. The project is part of the Bridging Interventional Development Gaps program, which is funded by the National Institutes of Health (NIH) Common Fund and led by NIH’s National Center for Advancing Translational Sciences.

Therapeutic Hypothermia and Temperature Management Symposium scheduled
The Department of Neurological Surgery at the University of Miami Miller School of Medicine in Miami, Fla., will present the 4th Annual “Therapeutic Hypothermia and Temperature Management: Current and Future” symposium on March 6–7, 2014. The event includes lectures by authorities in the field and roundtable discussions, so participants can talk about obstacles to targeted temperature management and learn from each other. 

Therapeutic hypothermia for in-hospital cardiac arrest?
In the December 2013 Therapeutic Hypothermia and Temperature Management Arctic Challenge, Claranne Mathiesen, RN, MSN, CNRN, director of Medical Operations Neurosciences at Lehigh Valley Hospital in Allentown, Pa., answered a question about whether evidence exists that shows a beneficial effect of therapeutic hypothermia when treating patients with an in-hospital cardiac arrest. She indicated that a lack of well-designed studies for in-hospital events exists. She cited an American Heart Association consensus statement for improving outcomes after in-hospital cardiac arrest, which she felt raised more questions than provided answers. Mathisesen reported on a couple of studies that looked at cooling for in-hospital cardiac arrests but said they either referenced knowledge gaps or found no association with improved or worsened survival. All studies and the Heart Association make a case for further research. 

Therapeutic hypothermia after recanalization in stroke may reduce complications
Cooled patients with an ischemic stroke may be at lower risk for cerebral edema and hemorrhagic transformation, according to a South Korean study reported in the journal Stroke. The researchers conducted a prospective cohort study at two stroke centers and enrolled 75 patients after a successful recanalization. Patients at one center were cooled to 34.5° C for 48 hours and then rewarmed during a two-day period. Patients at the second center received the standard of care set by guidelines but no cooling. The patients receiving therapeutic hypotherapy achieved better outcomes. 

Texas hospital cools newborns during ambulance transport
Texas Children’s Hospital in Houston is the first hospital in Texas to offer whole body, active cooling for oxygen-deprived newborns during ambulance transport to the hospital’s level IV neonatal intensive care unit (NICU). The infants will be cooled to 33.5° C and then kept at that temperature for 72 hours in the NICU before rewarming. Babies who receive cooling within six hours of birth have better outcomes, said Jeffrey R. Kaiser, a neonatologist at Texas Children's Hospital and director of the hospital's neonatal hypothermia program, adding that offering “active whole body cooling during transport means that we can begin cooling an oxygen-deprived infant much sooner, potentially saving more brain cells, which is critical to outcomes and can prevent fatalities and severe neurological damage that can lead to intellectual disability, cerebral palsy and epilepsy.”

Mild hypothermia protects against central nervous system injuries
Rami Dar and colleagues from Chongqing Medical University summarize and analyze mild hypothermia’s protective effects in a review article in Neural Regeneration Research. They explain the mechanisms by which therapeutic hypothermia protects against central nervous system injuries, including a decrease in free radical production, inflammation, excitotoxicity, and intracranial pressure, and better cerebral metabolism after traumatic brain injury and cerebral ischemia. The authors called cooling a highly promising treatment and said that understanding the positive and negative aspects of hypothermia can optimize protective effects.

Penn develops TTM app
A team from the Center for Technology Transfer at the University of Pennsylvania in Philadelphia has developed the mobile app Resuscor, “to improve the quality of cardiac arrest and post-arrest clinical care, for both hospitals and emergency services providers.” The smartphone app will provide just-in-time decision support for post-arrest targeted temperature management. The app offers clinical information, three-dimensional animations, short videos, text, and clinical calculators.

Cooling to 36° C as effective as 33° C after cardiac arrest
Among unconscious survivors of a presumed cardiac arrest suffered outside of the hospital, cooling to 36° C was as effective as lowering the body temperature to 33° C, according to an international study reported at the American Heart Association meeting and in the New England Journal of Medicine. The researchers randomly assigned more than 900 patients in the trial to receive targeted temperature management at either 33° C or 36° C. At the trial’s conclusion, half of the patients in the 33° C died compared with 48% in the 36° C cohort. At 180 days, 54% of those in the 33° C group and 52% of the 36° C group had died or were experiencing poor neurological function. Lower temperatures are associated with a higher risk of infection, bleeding and other side effects, said lead author Niklas Nielsen, researcher at Lund University in Sweeden.

Hypothermia improves perinatal stroke outcomes
Mary Jo Harbert, MD, assistant clinical professor at the University of California, San Diego School of Medicine, and colleagues conducted a small prospective cohort study to evaluate the potential benefit of using therapeutic hypothermia in patients with perinatal stroke associated with encephalopathy. Five of the 14 patients were cooled. Harbert reported at the Child Neurology Society annual meeting that at the initial follow-up at one year, they saw no difference in mean Mental Development Index scores, but at 30 months, the cooled group scored 31 points higher. The authors suggest additional larger studies are needed to learn if cooling improves outcomes in this population. 

CAPITAL CHILL trial gets under way
The University of Ottawa Heart Institute in Canada is currently recruiting participants for a single-center, randomized, double-blind prospective clinical trial called the Mild Versus Moderate Therapeutic Hypothermia in Out-of-hospital Cardiac Arrest Patients (CAPITAL CHILL). The team then plans to expand the trial to a multicenter project. The patients for this study will be recruited among comatose survivors of out-of-hospital cardiac arrest. The study aims to determine whether neurologic outcomes at six months are improved with moderate (31° C) versus mild (34° C) therapeutic hypothermia following return of spontaneous circulation in patients suffering an out-of-hospital arrest. They plan to enroll 340 adults and complete the study in August 2016. The primary outcome will be the proportion of patients experiencing death or a poor neurologic outcome at six months after out-of-hospital cardiac arrest.  


Farid G. Sadaka, MD

WEBINAR: Normothermia in Brain Injury
Featured Speaker: Farid G. Sadaka, MD
Mercy Hospital St. Louis/ St. Louis University St. Louis, MO

Recorded Session, Duration: 1 Hour

SCCM Pod-212 CCM: Therapeutic Hypothermia Following Sudden Cardiac Arrest

Jeffrey Guy, MD, MSc, MMHC, speaks with David R. Janz, MD, lead author on an article published in the December issue of Critical Care Medicine, “Hyperoxia is Associated with Increased Mortality in Patients Treated with Mild Therapeutic Hypothermia after Sudden Cardiac Arrest.” Investigators found that sudden cardiac arrest is associated with high hospital mortality and poor neurologic outcomes. Janz is a clinical fellow at Vanderbilt University School of Medicine in Nashville, Tennessee.

SCCM Pod-222: Therapeutic Hypothermia in Children
Michael Weinstein, MD, FACS, FCCP, speaks with Philip E. Empey, PharmD, PhD, BCPS, who discusses his Young Investigator Award winning abstract, “Phenytoin Concentrations Are Elevated in Children Receiving Therapeutic Hypothermia Following Traumatic Brain Injury,” which he presented on during the 42nd Critical Care Congress in San Juan, Puerto Rico. His research found that therapeutic hypothermia significantly reduced phenytoin elimination in children with severe traumatic brain injury leading to increased, supratherapeutic drug levels for an extended period of time after cooling. Dr. Empey is an Assistant Professor of Pharmacy and Therapeutics at the University of Pittsburgh in Pennsylvania. Released: 7/24/13


ENLS certificationNCS’ New ENLS Course Addresses the First Critical Hour of a Neurological Emergency
The Neurocritical Care Society (NCS) is a multidisciplinary, international organization whose mission is to improve outcomes for patients with life-threatening neurological illnesses.  Emergency Neurological Life Support (ENLS) has just been introduced and it is already drawing positive comments from career professionals. ENLS is designed to help standardize the approach to neurological emergencies during the first critical hour. Included in the 13 topic areas are Ischemic Stroke, Subarachnoid Hemorrhage and Traumatic Brain Injury – and others that are very relevant to improving outcomes. Besides physicians and nurses, ENLS is also recommended for physician assistants, pharmacists, residents and fellows – all members of the team confronted with a neurological emergency who want to enhance their knowledge and preparedness. The course provides 15 hours of Level 1 CME credit and two-year ENLS certification on completion.
More on ENLS     More on NCS


Chilling at the Beach


Expert Spotlight

Dr. Justin B. Lundbye

Dr. Justin B. Lundbye:

Justin B. Lundbye, MD, chief of cardiology at The Hospital of Central Connecticut in Hartford, participated in an expert panel discussion at the 3rd Annual Therapeutic Hypothermia and Temperature Management meeting in Miami, Florida, about Therapeutic Hypothermia in Post Cardiac Arrest, later reported in Therapeutic Hypothermia and Temperature Management. He indicated the need for more studies and to make new staff and residents aware of the procedures and how to manage a case in the middle of the night. He suggested that APRNs and nurse champions can help with the education. He also shared that at his hospital the prognosis is very poor in patients down in a nonshockable rhythm cardiac arrest for 17 minutes or more. Anecdotally, he reported that patients with previous myocardial infarction have done fine during therapeutic hypothermia after a new event, but those with cardiomyopathy and a very low ED due to a massive prior STEMI typically do not fare as well as other patients. 

The panel discussion article can be e found here.



Expert on the Move


Upcoming at NTI:
Mary Guanci



Satellite Breakfast Symposium

Objectives: Learning Objectives:
1. List two ways in which fever negatively
effects the brain.
2. Name two strategies that may be used
to reduce fever in the brain injured
3. State two strategies used to manage
shivering during Targeted Temperature
Management (TTM).

Mary McKenna Guanci Clinical Nurse Specialist, Neuroscience ICU
Massachusetts General Hospital
Date/ Time: May 20, 2014 (Tuesday) in Denver, CO.

Recent evidence has supported a more aggressive approach to fever management in the neuroscience patient population. Increases in the inflammatory response has been shown to increase edema formation and intracranial pressure. Fever management strategies that used advanced technologies have been implemented to control the brain’s inflammatory response and hopefully improve outcome. The clinician must understand the concepts and be aware of the nursing implications of these strategies.

Hypothermia Management in Neuro Patients

Mary Kay Bader, MSN, CCNS, FAHA

Faculty Profile:

Mary Kay Bader

Mary Kay Bader has been a nurse for 32 years with an emphasis in neuroscience/critical nurse for 29 years. She is certified as a CCRN, CNRN, and CCNS. In 2008, she was inducted as a FAHA. Practicing in a variety of hospitals (teaching/community) across the country, Ms. Bader has functioned in roles such as ICU staff nurse, trauma nurse responder, clinical educator, clinical faculty, and clinical nurse specialist. She has held clinical and joint faculty positions at Georgetown University and Loyola University of Chicago. Currently, Ms. Bader is employed at Mission Hospital in Mission Viejo CA as a neuroscience/critical care clinical nurse specialist working collaboratively with physicians, nurses, therapists, and pharmacists. Ms. Bader has published in the following journals: Journal of Trauma, Neurocritical Care, Critical Care Nurse, Journal of Neuroscience Nursing, Critical Care Nursing Clinics of North America, AACN Clinical Issues, Journal of Cardiovascular Nursing, Heart and Lung, Dimensions in Critical care,. Ms. Bader is the co-editor for the 2010 and 2004 AANN Core Curriculum for Neuroscience Nursing and serves as a consulting editor for AACN Advance Critical Care. She is co-editor of 2008 AACN AANN Protocols for Practice in Neuro Critical Care. Ms. Bader is serves on the Neurocritical Care Society Board of Directors. She is the recipient of a number of AACN Circle of Excellence Awards.

PRESENTATION TOPIC:  Normothermia and Hypothermia in Brain Injury

March the 18th for AACN in California
Kaiser Permanente Fonatana Medical Center
9961 Sierra Avenue
Fonatana, CA 92335

PRESENTATION TOPIC:  Normothermia and Hypothermia in Brain Injury

August 21, 2014
Islands Chapter of American Association of Critical Care Nurses (HIC-AACN) in Honolulu, HI.
Ala Mona Hotel
Honolulu, Hawaii




The Global Science Center does not endorse or recommend any products, processes, or services. The views and opinions of authors expressed in the Global Science Center "TTM Connection" Newsletter do not necessarily state or reflect those opinions of the Global Science Center and or the MSL team. The provided links to other internet sites or content are only for the convenience of the recipients.  The Global Science Center and or the MSL team is not responsible for the content of these external sites. 

It is not the intention to provide specific medical advice, but rather to provide recipients with educational material to better understand the role of TTM. Specific medical advice will not be provided, and on the behalf of the MSL team and or the Global Science Center we urge you to consult with a qualified health care provider to discuss the benefits and risks of any presented therapies. The information provided is not to constitute an "authoritative statement".