When is targeted temperature management (TTM) contraindicated?

Updated: Jul 26, 2019
  • Author: Alex Koyfman, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Induced hypothermia after pulseless electrical activity (PEA), asystole, or in-hospital arrest has not been fully studied. One large cohort study of cardiac arrest patients found that targeted temperature management (TTM) was not associated with good outcome in nonshockable patients. [41]  Three observational studies have found no improvement in discharge neurologic outcome with TTM in patients with nonshockable rhythms, [18, 41, 42]  although one study found reduced mortality at 6 months. [41]

Further investigation is needed, but TTM may be applied in these patients at the discretion of the treating practitioners. The practitioner should consider the most likely etiology of the cardiac arrest. For example, patients with PEA arrest due to septic shock may be poor candidates for hypothermia. Although their brain might benefit, the impairment to the immune system from hypothermia may be more significant.

Data from a study of prehospital hypothermia in 125 patients found that in those who had non-VF arrest—that is, PEA (n = 34), asystole (n = 39), or unknown rhythm (n = 1)—survival to hospital discharge was worse in the cooled group (6%) than in the noncooled group (20%). [36] This study was not intended or powered to detect differences in clinical outcome at discharge, but it raises concern regarding the use of hypothermia in patients with PEA or asystole and return of spontaneous circulation (ROSC) with hypothermia in the prehospital setting.

Induced hypothermia or TTM is not recommended for patients with an isolated respiratory arrest.

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