Temperature management and its role in cardiac arrest patients—a review

Body temperature is a highly regulated parameter in humans. Changes in body temperature have been recognised as signs of illness for at least 2000 years. However, in spite of numerous laboratory and clinical studies, the optimal therapeutic window for temperature management has not been discovered, even in a very relevant and highly researched population, such as survivors after cardiac arrest.

A review written by Dr. Andrej Markota and Dr. Kristijan Skok (corresponding authors) was published in Signa Vitae, which presents an overview of targeted temperature management in the field of intensive care medicine and cardiac arrest, including “Search method”, “Physiological basics of the human thermoregulation”, “The intensive care and disbalances in thermal regulation”, “Targeted temperature management basics and methods” and “Body temperature management after cardiac arrest”.

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Simplified presentation of the treatment protocol of comatose patients after OHCA.

The most common application of thermoregulation is therapeutic temperature management. A prominent example is the utilisation of this technique in post-cardiac arrest patients, who remain comatose after resuscitation. This technique has been in use for almost 20 years since the first major reports on its benefits in improving out-of-hospital cardiac arrest and in-hospital cardiac arrest survival as well as improving neurological outcome. Recently, the findings from one of the biggest targeted temperature international and multicentre trials to date have been published (TTM2 trial? https://ttm2trial.org/). The study surprisingly showed no difference in mortality between patients after out of hospital cardiac arrest, who underwent normo- or hypothermia. 

Dr. Markota and Dr. Skok add: “We might need to re-evaluate certain guidelines, recommendations, and perspectives.” 

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