Cardiac arrest is one of the most critical life-threatening conditions. After circulation is restored, protecting the brain from irreversible damage remains a major challenge. One method to prevent such injury is Targeted Temperature Management (TTM). This medical procedure improves outcomes in patients who have experienced cardiac arrest. What does TTM therapy entail, and what are its therapeutic benefits for the patient? We explain.
What is TTM in medical terminology?
TTM, or Targeted Temperature Management, is a controlled procedure involving the regulation of a patient’s body temperature. This treatment method is applied to individuals who have experienced cardiac arrest and subsequently achieved the return of spontaneous circulation (ROSC). The objective of TTM is to maintain the patient’s core body temperature between 32 °C and 36 °C for a duration determined by the attending physician, typically around 24 hours[1].
What is TTM? Medical application in practice
TTM is used to protect the nervous system—particularly the brain—from harmful processes that occur after circulation is restored. When the heart stops pumping blood, brain cells become deprived of oxygen. Upon restoration of circulation, reperfusion injury to the brain may occur. Lowering the body temperature slows cellular metabolism, thereby reducing the risk of neuronal death and permanent brain damage[2].
What is required for TTM therapy?
In clinical practice, TTM is performed using specialized equipment, such as therapeutic hypothermia devices. These systems are equipped with sensors that continuously monitor the patient’s body temperature. The patient is placed on a specialized cooling blanket or pad, whose function is regulated by the system to optimally cool—or rewarm, if necessary—the patient’s body.
Which patients are eligible for TTM?
Patients eligible for TTM are those who have experienced out-of-hospital cardiac arrest with successful return of spontaneous circulation. According to the American Heart Association (AHA) guidelines on TTM, this therapy is indicated for comatose patients:
- whose cardiac arrest was of cardiac origin, with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia;
- following in-hospital cardiac arrest, as well as patients presenting with non-shockable rhythms[3].
There are also contraindications for TTM, including coagulopathy, sepsis, hemodynamic instability, hemorrhagic stroke, and uncontrolled bleeding. Therapeutic hypothermia is additionally contraindicated in cardiac arrest caused by trauma[4]. Each patient requires an individualized assessment by an experienced medical team prior to initiation of TTM.
Targeted temperature management – patient benefits from TTM therapy
Since 2003, TTM has been recommended by the International Liaison Committee on Resuscitation due to the benefits therapeutic hypothermia offers patients[5]. These benefits include notably improved survival rates following cardiac and circulatory arrest. TTM also positively influences the neurological status of patients whose brain cells have been temporarily deprived of oxygen. This therapy helps prevent permanent and difficult-to-treat impairments of nervous system function, including brain damage.
What is TTM? A summary
TTM offers hope for patients who have experienced cardiac arrest. Therapeutic hypothermia helps improve their prognosis for recovery. For healthcare institutions, it represents an opportunity to raise the standards of care and achieve better treatment outcomes. Implementing a TTM program requires financial investment; however, the benefits of this investment are reflected in survival statistics and in the preservation of patients’ health.
Sources:
- https://www.umms.org/bwmc/health-services/inpatient/patient-education/targeted-temperature-management
- https://pmc.ncbi.nlm.nih.gov/articles/PMC5523092/
- https://www.ncbi.nlm.nih.gov/books/NBK556124/
- P. Krawczyk, A. Tarczyńska, G. Dziadek, M. Gołębiowski, A.A. Kononowicz. J. Andres, Implementation of targeted temperature management after cardiac arrest in Polish intensive care units. What has changed in the last five years? Kardiologia Polska 2017; 75, 7: 689–697.
[1] https://www.umms.org/bwmc/health-services/inpatient/patient-education/targeted-temperature-management
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC5523092/
[3] https://www.ncbi.nlm.nih.gov/books/NBK556124/
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC5523092/, https://www.ncbi.nlm.nih.gov/books/NBK556124/
[5] P. Krawczyk, A. Tarczyńska, G. Dziadek, M. Gołębiowski, A.A. Kononowicz. J. Andres, Implementation of targeted temperature management after cardiac arrest in Polish intensive care units. What has changed in the last five years?, Kardiologia Polska 2017; 75, 7: 689–697.
[10]https://pmc.ncbi.nlm.nih.gov/articles/PMC5523092/, https://www.ncbi.nlm.nih.gov/books/NBK556124/
[11] P. Krawczyk, A. Tarczyńska, G. Dziadek, M. Gołębiowski, A.A. Kononowicz. J. Andres, Implementation of targeted temperature management after cardiac arrest in Polish intensive care units. What has changed in the last five years?, Kardiologia Polska 2017; 75, 7: 689