Description
"Targeted Temperature Management" (TTM) is a critical care intervention aimed at improving neurological outcomes in patients following cardiac arrest or severe brain injury. This session will delve into the science behind TTM, including its physiological benefits, optimal temperature targets, and timing. It will also address current guidelines, practical challenges in implementation, and recent evidence questioning its universal applicability. Attendees will gain a clear understanding of when and how to use TTM effectively in various clinical scenarios.
Summary Listen
- Targeted Temperature Management (TTM) is a crucial intervention following cardiac arrest, aiming to mitigate secondary brain damage caused by hypoxia and reperfusion injury. The process involves controlled cooling to reduce cerebral blood flow and metabolic demands, thus decreasing oxygen requirements and cerebral edema. While traditionally focused on hypothermia, current guidelines advocate for individualized approaches, with options including therapeutic hypothermia (32-36°C) or therapeutic normothermia.
- Patient selection for TTM involves comatose individuals post-ROSC, prioritizing immediate implementation. While advanced age and CPR duration are not definitive exclusion criteria, they warrant careful consideration. Both shockable and non-shockable rhythms benefit from TTM, particularly in-hospital cardiac arrests. Pediatric cases follow a similar approach, aiming for normothermia to improve neurological outcomes.
- TTM involves four distinct phases: induction, maintenance, rewarming, and normothermia. Rapid cooling during the induction phase is essential, with meticulous management of shivering. The rewarming phase is the most critical due to potential complications like electrolyte imbalances (potassium), increased intracranial pressure, and insulin metabolism disturbances. Gradual rewarming and maintaining normothermia for at least 72 hours post-TTM are crucial.
- Complications of TTM affect multiple organ systems. Cardiovascular effects include bradycardia, decreased cardiac output, and arrhythmias. Respiratory considerations involve adjusting supplemental oxygen and ventilation rates. Immunosuppression increases the risk of infection, masking typical signs like fever. Coagulopathy, often undetectable through standard lab tests, requires careful monitoring.
- Renal function is also impacted by cold diuresis leading to potential hypovolemia and electrolyte imbalances, including hypomagnesemia and hypophosphatemia. Arterial blood gas interpretations require temperature correction due to altered solubility of oxygen and carbon dioxide at different temperatures. Insulin secretion is suppressed, causing hyperglycemia, while drug metabolism is affected due to decreased hepatic and renal function requiring dose adjustments of sedatives, neuromuscular blockers and antiarrhythmics.
Sample Certificate
About the Speakers
Dr. Emre Ozluer
Head of the Resuscitation Group of Emergency Medicine Association of Turkey, Turkey
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