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

Leong, Siew Hon Benjamin; Chan, Enoch Hin Kei; Ho, Benjamin Choon Heng; Yeo, Colin; Lew, Sennen Jin Wen; Sewa, Duu Wen; Lim, Shir Lynn; Lee, Chee Wan; Chia, Puey Ling; Lim, Tien Siang Eric; Lee, Eng Kiang; Ong, Marcus Eng Hock

doi:10.11622/smedj.2017067

Cited by 22 publications

(19 citation statements)

References 18 publications

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“…TTM after cardiac arrest reduces cerebral oxygen demand by decreasing the metabolic rate of the brain. Furthermore, TTM decreases the production of oxygen free radicals and the subsequent cellular damage [21,22].…”

Section: Discussionmentioning

confidence: 99%

Targeted temperature management after cardiac arrest: Updated meta-analysis of all-cause mortality and neurological outcomes

Abdalla

Mohamed

et al. 2019

IJC Heart & Vasculature

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Background Cardiac arrest carries high mortality and morbidity burden. Different studies showed conflicting data regarding outcomes of targeted temperature management (TTM) for cardiac arrest. The purpose of this meta-analysis is to systematically determine the effect of TTM on all-cause mortality and neurological outcomes after cardiac arrest. Methods We conducted a systematic search for randomized controlled trials in Pubmed, Cochrane & ScienceDirect. Primary outcomes were neurological outcome and all-cause mortality. Results Nine randomized controlled trials utilizing data for in-hospital and out-of-hospital cardiac arrest were selected for meta-analysis. Total number of patients included was 1592. Mortality was lower in targeted temperature management group (OR 0.637, 95% CI 0.436–0.93, p-value 0.019, I 2 = 44.78%, n = 1592). Therapeutic hypothermia group also demonstrated reduction in poor neurological outcomes (OR 0.582, 95% CI 0.363–931, p-value 0.024, I 2 = 56.79%, n = 1567). Subgroup analysis was conducted, after excluding in-hospital cardiac arrest patients, and demonstrated reduction in poor neurological outcome (OR 0.562, 95% CI 0.331–0.955, p-value 0.033, I 2 = 61.78%, n = 1480) and mortality in out-of-hospital cardiac arrest patients (OR 0.674, 95% CI 0.454–999, p-value 0.049, I 2 = 43.8%, n = 1505). Conclusion Targeted temperature management after cardiac arrest may be associated with improvement in all-cause mortality and reduction in poor neurological outcome.

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Section: Discussionmentioning

confidence: 99%

Targeted temperature management after cardiac arrest: Updated meta-analysis of all-cause mortality and neurological outcomes

Abdalla

Mohamed

et al. 2019

IJC Heart & Vasculature

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“…There are several pathophysiological mechanisms that occur after resuscitation from cardiac arrest, which are united under the term called postcardiac arrest syndrome. This syndrome comprises four parts (Dion, Stephen, Duffy, & Kaye, 2011; Leong et al, 2017; Milonas et al, 2017):…”

Section: Thermoregulatory Mechanisms In Pathological Conditionsmentioning

confidence: 99%

“…The underlying observed beneficial effects of TTM in cardiac arrest are believed to result from the reduction of brain metabolism (a decrease of 6% for every 1°C drop in CBT, which also reduces the cerebral oxygen demand); reduction in the release of excitatory amino acids, free radicals and the intracellular consequences of excitotoxic exposure, which lessens the effect of the ischemia–reperfusion cascade, alongside possible cardioprotective effects. However, it must be stressed that lower temperatures (below 30°C) are associated with an increased risk of sepsis, brady‐arrythmias, coagulopathy and must therefore be avoided (Leong et al, 2017).…”

Section: Thermoregulatory Mechanisms In Pathological Conditionsmentioning

confidence: 99%

Thermoregulation: A journey from physiology to computational models and the intensive care unit

Skok

Duh

Stožer

et al. 2020

WIREs Mechanisms of Disease

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Thermoregulation plays a vital role in homeostasis. Many species of animals as well as humans have evolved various physiological mechanisms for body temperature control, which are characteristically flexible and enable a fine‐tuned spatial and temporal regulation of body temperature in different environmental conditions and circumstances. Human beings normally maintain a core body temperature at around 37°C, and maintenance of this relatively high temperature is critical for survival. Therefore, principles of thermoregulatory control have also important clinical implications. Infections can cause the body temperature to rise internally and several diseases can cause a dysfunction of thermoregulatory mechanisms. Moreover, the utilization of thermotherapies in treating various diseases has been known for thousands of years with a recent resurgence of interest. An increasing amount of research suggests that targeted temperature management is of paramount importance to patient outcomes in certain clinical scenarios. We provide a concise summary of the basic concepts of thermoregulation. Emphasis is given to the principles of thermoregulation in humans in basic pathological states and to targeted temperature management strategies in the clinical environment, with special attention on therapeutic hypothermia in postcardiac arrest patients. Finally, the discussion is focused on the potential offered by computational thermophysiological models for predicting thermal responses of patients in various clinical circumstances, for proposing new perspectives in the design of novel thermal therapies, and to optimize targeted temperature management strategies.This article is categorized under: Cardiovascular Diseases > Computational Models Cardiovascular Diseases > Environmental Factors Cardiovascular Diseases > Biomedical Engineering

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“…Thus, the patient in Case 1 was also given therapeutic hypothermia, which could have contributed to a favourable neurological recovery. (8,9) Although the rate of bystander CPR in Singapore remained at a low of about 20% until 2011, the implementation of dispatcher-assisted CPR by the Singapore Civil Defence Force has led to a rise in bystander CPR rates, to 49% in 2015. (10)(11)(12) Thus, dispatcher-assisted CPR may improve outcomes in patients with out-of-hospital cardiac arrest in Singapore.…”

Section: A 6bmentioning

confidence: 99%

Isolated right ventricle infarction

Woo

Kong

Ambhore

et al. 2019

smedj

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A 42-year-old man with no significant past medical history or known cardiovascular risk factors had an out-of-hospital cardiac arrest while jogging. He received bystander cardiopulmonary resuscitation (CPR) immediately. Within five minutes of his collapse, paramedics arrived and used an automatic external defibrillator (AED) on him. Spontaneous circulation was re-established after the second cycle of CPR, with spontaneous breathing effort. He was taken to the local hospital emergency department and intubated, as he did not regain consciousness. What does the electrocardiogram (ECG) in Fig. 1 show? ECG INTERPRETATION The initial ECG showed sinus rhythm (Fig. 1). There was marked ST elevation in lead V1 and mild ST elevation in lead aVR. There was subtle ST depression from leads V3 to V5 and minimal ST elevation in lead III.

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

Cited by 22 publications

References 18 publications

Targeted temperature management after cardiac arrest: Updated meta-analysis of all-cause mortality and neurological outcomes

Targeted temperature management after cardiac arrest: Updated meta-analysis of all-cause mortality and neurological outcomes

Thermoregulation: A journey from physiology to computational models and the intensive care unit

Isolated right ventricle infarction

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