Therapeutic Hypothermia and Targeted Temperature Management (TTM)
Summary
After return of spontaneous circulation (ROSC) in a comatose adult, institute active temperature control (TTM) with a feedback‑controlled device to either maintain mild hypothermia or strict normothermia. Typical target range is 32-36°C (many UK units use 36°C).
Maintain the chosen target for at least 24 hours and continue active fever prevention for 48-72 hours. Defer definitive neurological prognostication until confounders (hypothermia, sedation, neuromuscular blockade, metabolic instability) have resolved-usually ≥72 hours (NICE HTG710; Resuscitation Council UK).
Rationale
Global cerebral ischaemia during cardiac arrest triggers reperfusion cascades that are amplified by hyperthermia. TTM is an active, monitored strategy to prevent pyrexia and, when chosen, to maintain a controlled lower core temperature to reduce metabolic demand, limit reperfusion injury and cerebral oedema.
Contemporary guidance emphasises controlled temperature management with continuous feedback rather than uncontrolled or routine deep cooling (NICE HTG710; Resuscitation Council UK).
Indications and patient selection
- Indication: adult patients who remain comatose (do not follow commands) after ROSC following out‑of‑hospital cardiac arrest (OHCA) or in‑hospital cardiac arrest (IHCA), unless there are clear immediate contraindications or unsurvivable injuries.
- TTM is recommended for adults with OHCA who are unresponsive after ROSC regardless of initial rhythm and is generally recommended for comatose IHCA survivors (Resuscitation Council UK; ILCOR).
- Do not exclude patients solely on the basis of...