Targeted Temperature Management for 48 vs 24 Hours and Neurological Outcome After Out-of-Hospital Cardiac Arrest

Krikegaard. JAMA 2017: 25;318(4):341-350 doi: 10.1001/jama.2017.8978

Clinical Question

-  In adults with out of hospital cardiac arrest (OOHCA) due to a presumed cardiac cause, who are post ‘return of spontaneous circulation’ (ROSC), does cooling to 33°C for 48 hours, compared with 24 hours, improve improved neurological outcomes at 6 months?

N = 355, 10 ICUs in Europe

Authors’ Conclusions

-  The authors conclude that this study did not show a difference for primary outcome, however they feel that their study may have had limited power to detect what may be a clinical important difference and suggest further research may be warranted.

The Bottom Line

-  In patients with an out-of-hospital cardiac arrest of presumed cardiac origin, this study reported that maintaining temperature at 33 degrees for 24 vs 48 hours resulted in no significant difference in neurologic outcome.
-  If we consider adverse outcomes and implications for distributions of resources, these results may also point toward possible disadvantages to cooling for more than 24 hours.
-  My current practice is to use targeted temperature management to a target of 36C for 30 hours followed by avoidance of pyrexia for 24-48 hours. Based on this study I will not change this practice.
-  Hopefully the outcome of TTM2 will help shed some further light on best evidence based practice in this area