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Minerva Anestesiologica 2020 May 28

DOI: 10.23736/S0375-9393.20.14399-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

A practical approach to the use of targeted temperature management after cardiac arrest

Filippo ANNONI 1, Katia DONADELLO 2, Leda NOBILE 1, Fabio S. TACCONE 1

1 Department of Intensive Care, Erasme University Hospital Université Libre de Bruxelles, Brussels, Belgium; 2 Department of Anesthesia and Intensive Care B, University of Verona AOUI-University Hospital Integrated Trust, Verona, Italy


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Among comatose survivors after cardiac arrest, target temperature management (TTM) is considered the most effective treatment to reduce the consequences of post-anoxic brain injury. Several international guidelines have thus incorporated TTM in the management of the post- resuscitation phase. However, despite extremely promising results in animal models and in randomized trials including selected patient cohorts, TTM benefits on neurological outcome have been questioned. Moreover, TTM potential side effects have raised some concerns on its wide application in all cardiac arrest patients in different healthcare systems. There is indeed still relatively large uncertainty concerning some practical aspects related to TTM application, such as: a) how to select patients who will benefit the most from TTM; b) the optimal time to initiate TTM; c) the best target temperature; d) the most effective methods to provide TTM; e) the length of the cooling phase; f) the optimal rewarming rate and fever control strategies. The purpose of this manuscript is to review and discuss the most recent advances in TTM use after cardiac arrest and to give some proposals on how to deal with all these relevant practical questions.


KEY WORDS: Cardiac arrest; Post-anoxic brain injury; Target temperature management

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