References
Letters
Dear Editor,
I was interested to read your published paper on targeted temperature management (TTM) in the latest edition of Journal of Paramedic Practice written by Kelley Ricketts and Bridie Jones. I have a couple of comments that I feel are relevant after recently researching TTM myself.
At best, the efficacy of therapeutic hypothermia remains highly debatable. The HACA (Hypothermia after Cardiac Arrest Study Group, 2002) trial showed clear TTM benefits and changed protocol, then 11 years later, Nielsen et al's (2013) large trial showed no benefit in cooling (both were limited in methodology and prompted questions over generalisability). However, despite the shortcomings of Nielsen et al's trial, its effects were far-reaching, influencing cooling protocols and restricting further trials into TTM (Bernard et al, 2016; McDonnell, 2018). Indeed, the RINSE trial you cited in your paper was an example of a trial being stopped early as hospitals were changing protocol in TTM from 33oC to 36oC based on Nielsen's (2013) findings.
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