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Targeted temperature management: It is not yet time to change your target temperature

  • David Clinkard (a1), Andrew Cameron (a1), Daniel Howes (a1) (a2) and Ian Ball (a3) (a4)

Abstract

Clinical question

In unconscious patients of out-of-hospital cardiac arrest, does targeted temperature management to 36°C (96.8°F) improve outcomes compared to the standard target of 32°C–34°C (89.6°F–93.2°F)?

Article chosen

Nielson N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med 2013;369:2197-2206.

Objective

To determine which temperature, 33°C (91.4°F) or 36°C (96.8°F), is associated with lower mortality and better neurologic function after cardiac arrest.

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Copyright

Corresponding author

Correspondence to: David Clinkard, Undergraduate Medical Education, Queen’s University, 80 Barrie Street, Kingston, ON K7L 3N6; dclinkard@qmed.ca.

Footnotes

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This article has been peer reviewed.

Footnotes

References

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1. Bernard, SA, Gray, TW, Buist, MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002;346(8):557-563.
2. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002;346(8):549-556.
3. Hachimi-Idrissi, S, Corne, L, Ebinger, G, et al. Mild hypothermia induced by a helmet device: a clinical feasibility study. Resuscitation 2001;51(3):275-281.
4. Arrich, J, Holzer, M, Havel, C, et al. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Syst Rev 2012;9:CD004128.
5. Nielsen, N, Wetterslev, J, Al-Subaie, N, et al. Target temperature management after out-of-hospital cardiac arrest—a randomized, parallel-group, assessor-blinded clinical trial—rationale and design. Am Heart J 2012;163(4):541-548.
6. Lesaffre, E. Superiority, equivalence, and non-inferiority trials. Bull NYU Hosp Jt Dis 2008;66(2):150-154.
7. Nielsen, N. Canadian guidelines of the use of targeted temperature management (TTM) [Email]. Message to: Daniel Howes. January 8, 2014.
8. Field, JM, Hazinski, MF, Sayre, MR, et al. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S640-S656.
9. Nielsen, N, Wetterslev, J, Cronberg, T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med 2013;369(23):2197-2206.

Keywords

Targeted temperature management: It is not yet time to change your target temperature

  • David Clinkard (a1), Andrew Cameron (a1), Daniel Howes (a1) (a2) and Ian Ball (a3) (a4)

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