Targeted temperature management

Targeted temperature management
Other namesTherapeutic hypothermia
ICD-10-PCS6A4
MeSHC18.452.394.750
OPS-301 code8-607

Targeted temperature management (TTM) previously known as therapeutic hypothermia or protective hypothermia is an active treatment that tries to achieve and maintain a specific body temperature in a person for a specific duration of time in an effort to improve health outcomes during recovery after a period of stopped blood flow to the brain.[1] This is done in an attempt to reduce the risk of tissue injury following lack of blood flow.[2] Periods of poor blood flow may be due to cardiac arrest or the blockage of an artery by a clot as in the case of a stroke.[3]

Targeted temperature management improves survival and brain function following resuscitation from cardiac arrest.[4] Evidence supports its use following certain types of cardiac arrest in which an individual does not regain consciousness.[1] The target temperature is often between 32 and 34 °C.[4] Targeted temperature management following traumatic brain injury is of unclear benefit.[5] While associated with some complications, these are generally mild.[6]

Targeted temperature management is thought to prevent brain injury by several methods, including decreasing the brain's oxygen demand, reducing the production of neurotransmitters like glutamate, as well as reducing free radicals that might damage the brain. Body temperature may be lowered by many means, including cooling blankets, cooling helmets, cooling catheters, ice packs and ice water lavage.

  1. ^ a b Peberdy, MA; Callaway, CW; Neumar, RW; Geocadin, RG; Zimmerman, JL; Donnino, M; Gabrielli, A; Silvers, SM; Zaritsky, AL; Merchant, R; Vanden Hoek, TL; Kronick, SL; American Heart, Association (2 November 2010). "Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S768–786. doi:10.1161/CIRCULATIONAHA.110.971002. PMID 20956225.
  2. ^ Bernard, Stephen A.; Gray, Timothy W.; Buist, Michael D.; Jones, Bruce M.; Silvester, William; Gutteridge, Geoff; Smith, Karen (21 February 2002). "Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced Hypothermia". New England Journal of Medicine. 346 (8): 557–563. doi:10.1056/NEJMoa003289. PMID 11856794.
  3. ^ "Therapeutic Hypothermia After Cardiac Arrest". Johns Hopkins Medicine Health Library. Retrieved October 22, 2017.
  4. ^ a b Arrich, Jasmin; Schütz, Nikola; Oppenauer, Julia; Vendt, Janne; Holzer, Michael; Havel, Christof; Herkner, Harald (2023-05-22). "Hypothermia for neuroprotection in adults after cardiac arrest". The Cochrane Database of Systematic Reviews. 5 (5): CD004128. doi:10.1002/14651858.CD004128.pub5. ISSN 1469-493X. PMC 10202224. PMID 37217440.
  5. ^ Lewis, Sharon R.; Evans, David Jw; Butler, Andrew R.; Schofield-Robinson, Oliver J.; Alderson, Phil (September 21, 2017). "Hypothermia for traumatic brain injury". The Cochrane Database of Systematic Reviews. 2017 (9): CD001048. doi:10.1002/14651858.CD001048.pub5. ISSN 1469-493X. PMC 6483736. PMID 28933514.
  6. ^ Xiao, G.; Guo, Q.; Shu, M.; Xie, X.; Deng, J.; Zhu, Y.; Wan, C. (2012). "Safety profile and outcome of mild therapeutic hypothermia in patients following cardiac arrest: Systematic review and meta-analysis". Emergency Medicine Journal. 30 (2): 91–100. doi:10.1136/emermed-2012-201120. PMID 22660549. S2CID 23723711.