TTM for Cardiac Arrest: Shockable Rhythms, Non-Shockable Rhythms, and Hypothermia

In this video, we explore the use of targeted temperature management (TTM) in patients with cardiac arrest, including those with shockable and non-shockable rhythms, and the role of hypothermia in improving outcomes. We review the early trials that led to the development of TTM guidelines and discuss the results of recent multicenter randomized controlled trials, including TTM-1 and TTM-2. We also examine the results of trials such as HYPERION and Wolfrum et al that evaluated TTM in non-shockable rhythms.
Key takeaways:
TTM has been found to increase survival with good neurologic outcome in patients presenting with an out of hospital cardiac arrest (OHCA) with shockable rhythms
The American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR) 2015 guidelines recommend maintaining temperatures between 32°C and 36°C in the immediate post-arrest period
TTM to 33°C was not associated with a statistically significant improvement in mortality, composite of death or poor neurologic function, or total complications compared to 36°C in TTM-1 trial
TTM-2 trial found no difference in the primary outcome of mortality or secondary outcome of neurologic function at six months between 32°C and 37.5°C, and demonstrated that 32°C was associated with an increased risk of arrhythmias resulting in hemodynamic compromise
HYPERION trial concluded a statistically significant increase in survival with good neurologic outcome in 33°C compared to 37°C for OHCA and in-hospital cardiac arrest patients (IHCA) with no difference in death at 90 days across the groups
TTM can limit complications associated with shivering and cardiac arrhythmias
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