Chalk Talk: Targeted Temperature Management

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Video reviewing Targeted Temperature Management (TTM) after cardiac arrest with return of spontaneous circulation (ROSC). In the video we review indications for TTM, phases of TTM (induction, maintenance, and rewarming), implications of the landmark TTM Trial from 2013, and potential complications of TTM. Video created by Daniel Gergen.
References in order of appearance:
1. HYPERION: Lascarrou J-B, Merdji H, Le Gouge A, et al. Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm. New England Journal of Medicine. 2019;381(24):2327-2337.
2. Bernard SA, Gray TW, Buist MD, et al. Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced Hypothermia. New England Journal of Medicine. 2002;346(8):557-563.
3. Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest. New England Journal of Medicine. 2002;346(8):549-556.
4. De Fazio C, Skrifvars MB, Søreide E, et al. Intravascular versus surface cooling for targeted temperature management after out-of-hospital cardiac arrest: an analysis of the TTH48 trial. Critical Care. 2019;23(1):61.
5. Nielsen N, Wetterslev J, Cronberg T, et al. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. New England Journal of Medicine. 2013;369(23):2197-2206.
6. TTH48: Kirkegaard H, Søreide E, de Haas I, et al. Targeted Temperature Management for 48 vs 24 Hours and Neurologic Outcome After Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. Jama. 2017;318(4):341-350.
7. Possible benefit of 33 C: Testori C, Sterz F, Holzer M, et al. The beneficial effect of mild therapeutic hypothermia depends on the time of complete circulatory standstill in patients with cardiac arrest. Resuscitation. 2012;83(5):596-601.
8. Dankiewicz J, Friberg H, Bělohlávek J, et al. Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C. Resuscitation. 2016;99:44-49.
9. Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. 2015;95:202-222.
10. François B, Cariou A, Clere-Jehl R, et al. Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest. New England Journal of Medicine. 2019;381(19):1831-1842.

[@splendoc]

Thank you very much.

[@lamtrunghieu]

Thanks You for a meaningful video

[@dotnotes6651]

Daniel geargen... A Great job ... LOVE FROM EMERGENCY MEDICINE DEPARTMENT AND OUR TEAM

[@ems1632]

Hi. Can u tell rate of fluid when strating TTM. I'm just confused because in AHA guidelines its stated there to administer it in rapid rate