Targeted Temperature Management (TTM)2, previously known as therapeutic hypothermia, of 32-36oC degrees for ≥ 24h with prevention of fever (temperature >37.5oC) is suggested to be neuroprotective.1
TTM should be considered in OHCA survivors who remain unresponsive after ROSC
Shivering should be treated with adequate sedation +/- neuromuscular blockade.
Rewarm by 0.25-0.5 degrees oC/hour after 24 hours of TTM to normothermia1
Contraindications to TTM: severe systemic infection, pre-existing medical coagulopathy, cardiac dysrhythmias.1
Optimise haemodynamics
Target MAP/ SBP to achieve adequate urine output (0.5-1ml/kg/hr), with a normal/ decreasing plasma lactate1,3
Bradycardias associated with induced hypothermia ≤40 bpm may be left untreated (as long as BP and lactate are adequate)
Some centres use intra-aortic balloon pumps (IABP) in patients with cardiogenic shock – however, IABP-SHOCK II trial failed to show improvements in 30-day mortality
Consider implantable cardioverter defibrillator (ICD) placement in patients with significant left ventricular dysfunction or persistent ventricular arrhythmias >24h after primary coronary event (in most circumstances, this will be once the patient has been discharged from the critical care unit).1
Normoglycaemia
Aim blood ≤10 mmol/L and avoid hypoglycaemia.1
Do not implement strict glucose control as this increases risk of hypoglycaemia and associated complications
Diagnose/ treat seizures
Routine seizure prophylaxis is not recommended1
Echo
To optimise cardiac output and estimate myocardial recovery.
Delay prognostication for ≥72hrs after rewarming
Neurological prognostication remains a challenge and should involve combining results of the following: physical examination (particularly pupillary response, corneal reflex and best motor response), electroencephalogram (EEG), neuroimaging of CT or MRI, somatosensory evoked potentials (SSEPs) and neurone-specific enolase (NSE) levels (if available).
