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management
critical care
out-of-hospital
cardiac arrest
prehospital

Targeted temperature management: beneficial or not?

02 June 2020
Features
02 June 2020
Volume 12 · Issue 6

Abstract

Targeted temperature management (TTM), formerly known as therapeutic hypothermia, has been shown to improve survival and neurological recovery in patients following cardiac arrest. Following successes with its in-hospital implementation, many guidelines now advocate its use in the prehospital domain for all out-of-hospital cardiac arrests (OHCAs). It has been suggested that patients presenting with shockable rhythms who receive early initiation of TTM have better survival rates. TTM can be initiated in the prehospital setting with minimal equipment. This article discusses and explores the potential benefits and pitfalls of targeted temperature management when initiated in the prehospital environment. Particular focus is given to potential treatment strategies that can be used by paramedics to adequately manage OHCA. It is proposed that prehospital TTM is advantageous to all patients in cardiac arrest and can be efficacious in a variety of prehospital environments, with its implementation requiring only minimal equipment.

Cardiac arrest is a leading cause of sudden and unexpected death worldwide. It transpires primarily when the electrical conduction system of the myocardium malfunctions, preventing electrical impulses from propagating through the atria and ventricles, inhibiting the heart's ability to pump (Klaubunde, 2012). The efficiency of the heart's pumping ability is directly connected to the conduction pathway; if one begins to cease, the performance of the other will fail, and cardiac arrest will follow in consequence (Tortora and Derrickson, 2017).

Cardiac arrest, which has multiple aetiologies, is a time-critical condition; if not treated within minutes, death is almost certain (National Heart Lung and Blood Institute, 2016). Within the UK, 30 000 arrests occur per annum outside hospital (52 cases per 100 000 inhabitants) (UK National Cardiac Arrest Audit, 2018). Compared with other developed countries such as Norway, where survival to discharge is 25%, the UK has deficient survival rates, with the chances of survival to hospital after out-of-hospital cardiac arrest (OHCA) merely 10%, and to hospital discharge 7.6% (Lindner et al; 2011; Welsh Assembly Government, 2017).

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Out-of-hospital cardiac arrest
Targeted temperature management
Therapeutic hypothermia
Neuroprotection