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Macken looks with a cool and calculating eye at the application of therapeutic hypothermia following out of hospital cardiac arrest.
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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