TTM in TH

Q; Recently for Therapeutic Hypothermia, 36°C for 24 hours has been recommended for otherwise non-complicated patient in coma after cardiac arrest. In which situations still lower temperature at 33°C for 24 hours is recommended?

Answer:  Studies have shown similar outcomes in non-complicated patients with either 36°C or 33°C for 24 hours. 

36°C is sufficient for patients 

• in coma but still, exhibit some motor response, 
• no malignant EEG patterns,  
• no cerebral edema 

Otherwise 32°C to 34°C should be applied for patients 

• in deep coma
• EEG c/w seizure
• cerebral edema

References:

1. Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med 2013; 369:2197.

2. Arrich J, Holzer M, Havel C, et al. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Syst Rev 2016; 2:CD004128.