Canadian Guidelines for the use of targeted temperature management (therapeutic hypothermia) after cardiac arrest: A joint statement from The Canadian Critical Care Society (CCCS), Canadian Neurocritical Care Society (CNCCS), and the Canadian Critical Care Trials Group (CCCTG)

Howes, Daniel; Gray, Sara; Brooks, Steven C.; Boyd, J. Gordon; Djogovic, Dennis; Golan, Eyal; Green, Robert S.; Jacka, Michael J.; Sinuff, Tasnim; Chaplin, Timothy; Smith, Orla M.; Owen, Julian; Szulewski, Adam; Murphy, Laurel; Irvine, S. Rodman; Jichici, Draga; Muscedere, John

doi:10.1016/j.resuscitation.2015.07.052

Cited by 47 publications

(61 citation statements)

References 165 publications

(141 reference statements)

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“…The change was largely driven by the “TTM study” (Nielsen et al , 2013), which reported similar outcomes for patients treated with 33°C and 36°C target temperatures. There is some controversy regarding the revised range of target temperatures, and some have suggested that the use of slow, late cooling in the TTM study may have decreased the therapeutic benefit of the 33°C target temperature (Howes et al , 2015; Polderman and Varon, 2015a). …”

Section: Introductionmentioning

confidence: 99%

Time to Cooling Is Associated with Resuscitation Outcomes

Schock

Janata

Peacock

et al. 2016

Therapeutic Hypothermia and Temperature Management

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Our purpose was to analyze evidence related to timing of cooling from studies of targeted temperature management (TTM) after return of spontaneous circulation (ROSC) after cardiac arrest and to recommend directions for future therapy optimization. We conducted a preliminary review of studies of both animals and patients treated with post-ROSC TTM and hypothesized that a more rapid cooling strategy in the absence of volume-adding cold infusions would provide improved outcomes in comparison with slower cooling. We defined rapid cooling as the achievement of 34°C within 3.5 hours of ROSC without the use of volume-adding cold infusions, with a ≥3.0°C/hour rate of cooling. Using the PubMed database and a previously published systematic review, we identified clinical studies published from 2002 through 2014 related to TTM. Analysis included studies with time from collapse to ROSC of 20–30 minutes, reporting of time from ROSC to target temperature and rate of patients in ventricular tachycardia or ventricular fibrillation, and hypothermia maintained for 20–24 hours. The use of cardiopulmonary bypass as a cooling method was an exclusion criterion for this analysis. We compared all rapid cooling studies with all slower cooling studies of ≥100 patients. Eleven studies were initially identified for analysis, comprising 4091 patients. Two additional studies totaling 609 patients were added based on availability of unpublished data, bringing the total to 13 studies of 4700 patients. Outcomes for patients, dichotomized into faster and slower cooling approaches, were determined using weighted linear regression using IBM SPSS Statistics software. Rapid cooling without volume-adding cold infusions yielded a higher rate of good neurological recovery than slower cooling methods. Attainment of a temperature below 34°C within 3.5 hours of ROSC and using a cooling rate of more than 3°C/hour appear to be beneficial.

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Section: Introductionmentioning

confidence: 99%

Time to Cooling Is Associated with Resuscitation Outcomes

Schock

Janata

Peacock

et al. 2016

Therapeutic Hypothermia and Temperature Management

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“…(5,8) A meta-analysis by Kim et al (9) found that TTM was benefi cial for cases of nonshockable rhythms, although the included studies had substantial risk for bias. Although the level of evidence is low, TTM remains recommended for these patients.…”

Section: Therapeutic Temperature Management (Ttm)mentioning

confidence: 99%

“…(2,3,5,8) A subsequent RCT, which compared the target temperatures of 33°C vs. 36°C for cardiac arrests of all rhythms, found no difference in outcomes. (10) In the Nielsen et al study, both the intervention and the control groups were given some form of TTM.…”

Section: Target Temperature For Ttmmentioning

confidence: 99%

“…While there is low-quality evidence regarding the duration of cooling, most studies have suggested that rewarming should begin 24 hours after the patient has reached the target temperature. (6,8) Patients should not be rewarmed rapidly, as rapid rewarming has been associated with complications, including hypotension, electrolyte changes and dysrhythmias. It is recommended that rewarming should occur at a rate not faster than 0.5°C every hour until normothermia.…”

Section: Duration Of Ttm and Rewarmingmentioning

confidence: 99%

“…While no clinically signifi cant bleeding has been reported in large clinical trials, the benefi t to neurological function should be assessed against the severity and location of bleeding. (8) …”

Section: Haematologicalmentioning

confidence: 99%

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Therapeutic temperature management (TTM): post-resuscitation care for adult cardiac arrest, with recommendations from the National TTM Workgroup

Leong¹,

Chan²,

Ho³

et al. 2017

smedj

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Therapeutic temperature management (TTM) was strongly recommended by the 2015 International Liaison Committee on Resuscitation as a component of post-resuscitation care. It has been known to be effective in improving the survival rate and neurologic functional outcome of patients after cardiac arrest. In an effort to increase local adoption of TTM as a standard of post-resuscitation care, this paper discusses and makes recommendations on the treatment for local providers.

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