Surgical Critical Care: Targeted Temperature Management

Targeted Temperature Management

Definitions

  • Therapeutic Hypothermia (TH): Induced Hypothermia Following Cardiac Arrest
    • Older Term Now Replaced by Targeted Temperature Management
  • Targeted Temperature Management (TTM): Strict Temperature Control Following Cardiac Arrest – Hypothermia is Not Necessarily a Required Component

Basics

  • Primary Indication: Post-Cardiac Arrest with Return of Spontaneous Circulation (ROSC) But No Purposeful Neurologic Activity
  • Purpose: Decrease Total Body Oxygen Demand
    • Improves Survival & Neurologic Outcomes
  • Only Absolute Contraindication: Advanced Directive or DNR Order
  • Relative Contraindications:
    • Active Bleeding
    • Pregnancy
    • Severe Sepsis
    • Recent Major Surgery
    • Trauma

Phases

  • Initiation Phase
    • Start as Soon as Possible After Return of Spontaneous Circulation (ROSC)
    • Goal – Reach Target Temperature Within 6 Hours
  • Maintenance Phase
    • Target Temperature: 32-36°C
    • Lasts for a Minimum of 24 Hours (Exact End-Point Not Clear)
    • Requires Sedation & Suppression of Shivering
    • Requires Frequent Monitoring of Labs Every 4 Hours
  • Rewarming
    • Method: Passive or Controlled Rewarming
    • Rewarming Rates: 0.25-0.50°C/Hour Until Normothermic

Complications of Cooling & Rewarming