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Concept
Targeted temperature management
Summary
Targeted temperature management (TTM) previously known as therapeutic hypothermia or protective hypothermia is an active treatment that tries to achieve and maintain a specific body temperature in a person for a specific duration of time in an effort to improve health outcomes during recovery after a period of stopped blood flow to the brain. This is done in an attempt to reduce the risk of tissue injury following lack of blood flow. Periods of poor blood flow may be due to cardiac arrest or the blockage of an artery by a clot as in the case of a stroke.
Targeted temperature management improves survival and brain function following resuscitation from cardiac arrest. Evidence supports its use following certain types of cardiac arrest in which an individual does not regain consciousness. The target temperature is often between 32-34°C. Targeted temperature management following traumatic brain injury is of unclear benefit. While associated with some complications, these are generally mild.
Targeted temperature management is thought to prevent brain injury by several methods, including decreasing the brain's oxygen demand, reducing the production of neurotransmitters like glutamate, as well as reducing free radicals that might damage the brain. Body temperature may be lowered by many means, including cooling blankets, cooling helmets, cooling catheters, ice packs and ice water lavage.
Targeted temperature management may be used in the following conditions:
The 2013 ILCOR and 2010 American Heart Association guidelines support the use of cooling following resuscitation from cardiac arrest. These recommendations were largely based on two trials from 2002 which showed improved survival and brain function when cooled to after cardiac arrest.
However, more recent research suggests that there is no benefit to cooling to when compared with less aggressive cooling only to a near-normal temperature of ; it appears cooling is effective because it prevents fever, a common complication seen after cardiac arrest.
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