TTM

Question 1

TTM studied for what population? Protocol?

Alternative protocols?

Answer 1

Comatose patients with initial rhythm of pulseless VT or VFib after out-of-hospital-cardiac arrest.
Protocol for therapeutic hypothermia, 32-24*C for 24 hours.
- pt needs to be hemodynamically stable (cardiogenic shock may be safe)

• 33C was not superior to 36C
• for OHCA of any rhythm, alternative protocol of 36* for 24hr, 8hr rewarming to 37, keep temp below 37.5 until 72hr (“likely as effective as TH and acceptible alternative).

Question 2

Mechanism of benefits of TTM

Answer 2

suppress oxidative stress/apoptosis/inflammation, early hyperemia and delayed hypoperfusion

Question 3

Contraindications to TTM

Answer 3

TM temp below 30* on admission
iif comatose before cardiac arrest
pregnant
terminally ill/ICU not appropriate
inherited coagulation disorders