Targeted Temperature Management (TTM) for Comatose Survivors of Cardiac Arrest

Animal data has long supported the concept of managing temperature by inducing hypothermia following cardiac arrest to improve neurological outcome. In 2002 two landmark trials were published in the New England Journal of Medicine (NEJM); A European multicentre trial with a total of 136 patients compared therapeutic hypothermia of 32-34 for 24 hours to normothermia and demonstrated 55% vs 39% favourable neurological outcome and a six month mortality of 41% vs 55% both favouring the hypothermia group, and a further Australian trial of 77 patients demonstrated a 49% vs 26% survival or good outcome using a similar target temperature for 12 hours. Both of these studies were of out of hospital cardiac arrests with ventricular fibrillation as the presenting rhythm. In the decade since there publication therapeutic hypothermia has been recommended by multiple national and international resuscitation groups and has become a standard of care for all comatose survivors of non-traumatic cardiac arrest.