Hypothermia management no longer recommended post cardiac arrest?

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New facility I work at does not recommend hypothermia post cardiac arrest for unresponsive patients and says new data shows that it isn’t anymore beneficial than not doing it. They also rarely consult neurology (I work in MICU). I came from a trauma 1 teaching hospital and the way this unit operates is very different to me (I will post separate questions!). Is it common practice now to ditch hypothermia management?!?

chare

3,567 Posts

While the American Heart Association still includes target temperature management (TTM) in their post cardiac arrest management for comatose patients, there really isn't a lot of evidence to support.  From the American College of Cardiology's A  Contemporary Update on Targeted Temperature Management:

Quote

Although, targeted temperature management is strongly recommended for neuroprotection in patients who remain comatose after resuscitation from a cardiac arrest, this recommendation is based on weak evidence of benefit, mostly from earlier trials that had many limitations.

Recently, the Targeted Temperature Management-2 (TTM2) trial randomized 1,861 patients to targeted hypothermia (33°C) or targeted normothermia (37.8°C) and found no benefit of targeted hypothermia in improving survival at 6 months.

There was also no difference in survival with severe neurological disability or quality of life, but a higher risk of arrhythmia in hypothermia treated patients.

The TTM2 trial overcomes many of the limitations of earlier studies of hypothermia. Until future studies that compare other cooling strategies are completed, routine use of targeted hypothermia may no longer be necessary.

 

JBMmom, MSN, NP

Specializes in New Critical care NP, Critical care, Med-surg, LTC. Has 10 years experience. 4 Articles; 2,201 Posts

I found this article to give a very nice overview of why TTM is done from a mechanism standpoint: 

Targeted Temperature Management by Ahmad M. Omairi; Shivlal Pandey.

They cite a single RCT study that had a 49% vs 26% improvement in outcomes with the hypothermia group. But as @chare pointed out, there are not many strong studies out there.