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Published Online: 7 December 2015

Variability in Postarrest Targeted Temperature Management Practice: Implications of the 2015 Guidelines

Publication: Therapeutic Hypothermia and Temperature Management
Volume 5, Issue Number 4

Abstract

In 2002 postarrest care was significantly altered when multiple randomized controlled trials found that therapeutic hypothermia at a goal temperature of 32–34°C significantly improved survival and neurologic outcomes. In 2013, targeted temperature management (TTM) was reexamined via a randomized controlled trial between 33°C and 36°C in post-cardiac arrest patients and found similar outcomes in both cohorts. Before the release of the 2015 American Heart Association (AHA) Guidelines, our group found that across hospitals in the United States, and even within the same institution, TTM protocol variability existed. After the 2013 TTM trial, it was anticipated that the 2015 Guidelines would clarify which target temperature should be used during postarrest care. The AHA released their updates for post-cardiac arrest TTM recently and, based on the literature available, have recommended the use of TTM at a goal temperature between 32°C and 36°C. Whether this variability has an effect on TTM implementation or patient outcomes is unknown.

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References

Abella BS, Rhee JW, Huang KN, Vanden Hoek TL, Becker LB. Induced hypothermia is underused after resuscitation from cardiac arrest: A current practice survey. Resuscitation 2005;64:181–186.
Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002;346:557–563.
Callaway CW, Donnino MW, Fink EL, Geocadin RG, Eyal Golan E, Kern KB, Leary M, Meurer WJ, Peberdy MA, Thompson TM, Zimmerman JL. Part 8: Post-cardiac arrest care: 2015 American Heart Association Guidelines Update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132:S465–S482.
Clinkard D, Cameron A, Howes D, Ball I. Targeted temperature management: It is not yet time to change your target temperature. CJEM 2015;17:706–708.
De Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, Sutton RM, Tijssen JA, Topjian A, van der Jagt EW, Schexnayder SM, Samson RA. Part 12: Pediatric advanced life support: 2015 American Heart Association Guidelines Update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132:S526–S542.
Donnino MW, Andersen LW, Berg KM, Reynolds JC, Nolan JP, Morley PT, Lang E, Cocchi MN, Xanthos T, Callaway CW, Soar J; FRCA; FFICM; FRCP; ILCOR ALS Task Force. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation 2015;pii: S0300-9572(15)00817-5.
Edelson DP, Yuen TC, Mancini ME, Davis DP, Hunt EA, Miller JA, Abella BS. Hospital cardiac arrest resuscitation practice in the United States: A nationally representative survey. J Hosp Med 2014;9:353–357.
Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002;346:549–556.
Jacobs I, Nadkarni V. Targeted temperature management following cardiac arrest: An update. Available at: www.ilcor.org/data/TTM-ILCOR-update-Dec-2013.pdf (accessed October 16, 2015).
Leary M, Delfin G, Grossestreuer AV, Bobrow BJ, Santos J, Buckler B, Abella BS, Blewer AL. Variability in post-arrest targeted temperature management practice in the US: 33 vs 36°C. Circulation 2015;132:A1567.
Lopez-de-Sa E. What should be done with survivors of a cardiac arrest? Induce hypothermia or just avoid hyperthermia? Rev Esp Cardiol (Engl Ed) 2015;68:369–372.
Merchant RM, Soar J, Skrifvars MB, Silfvast T, Edelson DP, Ahmad F, Huang KN, Khan M, Vanden Hoek TL, Becker LB, Abella BS. Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest. Crit Care Med 2006;34:1935–1940.
Moler FW, Silverstein FS, Holubkov R, Slomine BS, Christensen JR, Nadkarni VM, Meert KL, Clark AE, Browning B, Pemberton VL, Page K, Shankaran S, Hutchison JS, Newith CJ, Bennett KS, Berger JT, Topjian A, Peneda JA, Koch JD, Schleien CL, Dalton HJ, Ofori-Amanfo G, Goodman DM, Fink EL, McQuillen P, Zimmerman JJ, Thomas NJ, van der Jagt EW, Porter MB, Meyer MT, Harrison R, Pham N, Schwarz AJ, Nowak JE, Alten J, Wheeler DS, Bhalala US, Lidsky K, Lloyd E, Mathur M, Shah S, Wu T, Theodorou AA, Sanders RC Jr., Dean JM THAPCA Trial Investigators. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med 2015;372:1898–1908.
Morrison LJ, Brooks SC, Dainty KN, Dorian P, Needham DM, Ferguson ND, Rubenfeld GD, Slutsky AS, Wax RS, Zwarenstein M, Thorpe K, Zhan C, Scales DC, Strategies for Post-Arrest Care Network. Improving use of targeted temperature management after out-of-hospital cardiac arrest: A stepped wedge cluster randomized controlled trial. Crit Care Med 2015;43:954–964.
Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Åneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Køber L, Langørgen J, Lilja G, Møller JE, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H, TTM Trial Investigators. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med 2013;369:2197–2206.
Nielsen N, Wetterslev J, Friberg H TTM Trial Steering Group. Targeted temperature management after cardiac arrest. N Engl J Med 2014;370:1360.
Polderman KH, Varon J. Interpreting the results of the targeted temperature management trial in cardiac arrest. Ther Hypothermia Temp Manag 2015;5:73–76.
Polderman KH, Varon J. We should not abandon therapeutic cooling after cardiac arrest. Crit Care 2014;18:130.
Wils EJ, van den Berg T, van Bommel J. Current practice of target temperature management post-cardiac arrest in the Netherlands, a post-TTM trial survey. Resuscitation 2015;pii: S0300-9572(15)00840-0.
Wise MP, Horn J, Åneman A, Nielsen N. Targeted temperature management after out-of-hospital cardiac arrest: Certainties and uncertainties. Crit Care 2014;18:459.

Information & Authors

Information

Published In

cover image Therapeutic Hypothermia and Temperature Management
Therapeutic Hypothermia and Temperature Management
Volume 5Issue Number 4December 2015
Pages: 184 - 187
PubMed: 26642933

History

Published online: 7 December 2015
Published in print: December 2015

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Marion Leary
Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
Audrey L. Blewer
Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Gail Delfin
Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Benjamin S. Abella
Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Section of Pulmonary Allergy and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

Notes

Address correspondence to:Marion Leary, RN, MSN, MPHDepartment of Emergency MedicineCenter for Resuscitation ScienceUniversity of PennsylvaniaSchool of NursingBlockley Hall 414, 423 Guardian DrivePhiladelphia, PA 19104E-mail: [email protected]

Author Disclosure Statement

M.L. has received research support from the Laerdal Foundation and the American Heart Association. M.L. has received in-kind support from Laerdal Medical and Physio-control. A.B. has received research support from the American Heart Association. B.S.A. has received honoraria from CR Bard and Stryker Medical, and research support from the National Institute of Health, the American Heart Association, Stryker Medical, and the Medtronic Foundation.

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