Interpreting the results of the targeted temperature management trial in cardiac arrest

Therapeutic Hypothermia and Temperature Management
Kees H Polderman, Joseph Varon

Abstract

The targeted temperature management (TTM) trial, which found that cooling to 33°C after witnessed cardiac arrest (CA) conferred no benefits compared with 36°C, has led to much debate in the hypothermia community. This article discusses what lessons can be drawn. The TTM trial achieved far better outcomes in controls than any previous randomized controlled trial (RCT) or any nonrandomized study where no fever control was applied. On the other hand, rates of good outcomes in the hypothermia group were somewhat lower than in previous RCTs and most nonrandomized studies. The TTM authors conclude that benefits of temperature management are derived exclusively from fever control and that further lowering of temperature confers no benefit. Indeed, without doubt, the TTM trial demonstrates the crucial importance of strict fever control after CA and that this provides sufficient neuroprotection for some patients. However, we argue that the hypothermia intervention was executed suboptimally (possibly inadvertent selection bias; late start of cooling, up to 4 hours after ROSC; slow cooling rates, 10 hours to target temperature; more rapid rewarming than previous studies; and some other issues). This could explain high rates of good outcom...Continue Reading

References

Sep 26, 2001·Archives of Internal Medicine·A ZeinerA N Laggner
Feb 22, 2002·The New England Journal of Medicine·UNKNOWN Hypothermia after Cardiac Arrest Study Group
Feb 22, 2002·The New England Journal of Medicine·Stephen A BernardKaren Smith
Mar 6, 2007·Critical Care Medicine·Jasmin Arrich, UNKNOWN European Resuscitation Council Hypothermia After Cardiac Arrest Registry Study Group
Mar 19, 2009·Journal of Neurotrauma·John T Povlishock, Enoch P Wei
Jun 26, 2009·Critical Care Medicine·Kees H Polderman
Oct 20, 2010·Resuscitation·Jerry P NolanUNKNOWN ERC Guidelines Writing Group
Oct 21, 2010·Critical Care Medicine·Greetje van der WalPeter Pickkers
Sep 29, 2011·BMJ : British Medical Journal·Andrew P WaldenMatt P Wise
Nov 19, 2013·The New England Journal of Medicine·Niklas NielsenUNKNOWN TTM Trial Investigators
Jul 17, 2014·Critical Care : the Official Journal of the Critical Care Forum·Kees H Polderman, Joseph Varon
Sep 4, 2014·Critical Care : the Official Journal of the Critical Care Forum·Matt P WiseNiklas Nielsen
Feb 19, 2015·Circulation·Kees H Polderman, Joseph Varon

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Citations

Dec 9, 2015·Therapeutic Hypothermia and Temperature Management·Marion LearyBenjamin S Abella
Nov 7, 2015·Therapeutic Hypothermia and Temperature Management·Justin LundbyeKees H Polderman
Dec 17, 2015·Best Practice & Research. Clinical Anaesthesiology·Maria VargasPaolo Pelosi
Aug 1, 2015·Therapeutic Hypothermia and Temperature Management·Benjamin S AbellaSamuel Tisherman
Apr 29, 2016·Journal of Intensive Care·Shoji Yokobori, Hiroyuki Yokota
Oct 21, 2016·Resuscitation·Salim Surani, Joseph Varon
May 4, 2017·Therapeutic Hypothermia and Temperature Management·Rishabh Charan Choudhary, Xiaofeng Jia
May 1, 2017·Resuscitation·Rachel M Riley, Joseph Varon
Oct 14, 2017·Therapeutic Hypothermia and Temperature Management·Jon RittenbergerKees H Polderman
Sep 13, 2019·Journal of Intensive Care Medicine·Peter M ReardonKrishan Yadav
Dec 7, 2019·Critical Care Medicine·Nicholas J JohnsonDavid J Carlbom
Aug 18, 2017·Acta Anaesthesiologica Scandinavica·L ArvidssonC Rylander
Dec 3, 2016·Therapeutic Hypothermia and Temperature Management·Robert B SchockFritz Sterz

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