What are the AHA guidelines for targeted temperature management (TTM)?

Updated: Jul 26, 2019
  • Author: Alex Koyfman, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Note the following [2] :

  • Induce hypothermia for unconscious adult patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest when the initial rhythm was VF or pVT (class I, level of evidence: B-R)

  • Similar therapy may be beneficial for patients with non-VF/non-pVT (nonshockable) arrest out-of-hospital or with in-hospital arrest (class I, level of evidence: C-EO)

  • The temperature should be maintained between 32ºC and 36ºC (class I, level of evidence: B-R)

  • It is reasonable to maintain TTM for at least 24 hours (class IIa, level of evidence: C-EO)

  • Routine prehospital cooling of patients with ROSC with IV rapid infusion is not advised (class III: no benefit; level of evidence A)

  • It is reasonable to prevent fever in comatose patients after TTM (class IIb, level of evidence C-LD) 

  • Hemodynamically stable patients with spontaneous mild hypothermia (>33°C) after resuscitation from cardiac arrest should not be actively rewarmed

Take home points

Note the following:

  • Have a plan and buy-in from necessary departments.

  • Experience with TTM is not needed to be successful.

  • Cool early (in the emergency department).

  • Use any cooling method.

  • Patients can continue to be cooled during percutaneous coronary intervention (PCI).

  • Use any pharmacologic agent necessary for primary cardiac condition (eg, aspirin, antiplatelet compounds, thrombolytics).

  • Treat patients as you would any critical care patient (tight glycemic control, vigilance for signs of infection, maintain perfusion, and use pressors if necessary).

  • Practice standard neuroprotective strategies such as placing the head of the bed at 30º and use seizure precautions.

  • Predict and be proactive regarding management of complications from ROSC and hypothermia, including shivering, fever, hypotension or hypertension, hyperglycemia, hypokalemia or hyperkalemia, bradycardia, and ongoing ischemia.

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