Discover and read the best of Twitter Threads about #TTM2
Most recents (4)
**Fever-prevention and Temperature Control after Cardiac Arrest**
Tomorrow, an important intervention from #BOXtrial will be presented by my supervisor prof @CHassager from @cardiac_group:
Device-based prevention of fever 🌡️ (after 24 hours of #TTM). This requires a tweetorial
Tomorrow, an important intervention from #BOXtrial will be presented by my supervisor prof @CHassager from @cardiac_group:
Device-based prevention of fever 🌡️ (after 24 hours of #TTM). This requires a tweetorial
Targeted temperature management (therapeutic hypothermia, now temperature control) has been the cornerstone of neuroprotection in patients resuscitated but comatose after #OHCA for the past 20 years
The exact mechanism of action is unknown.
Experimental data suggest that low temperature decreases the cerebral metabolic rate, and consequently reduces the release of excitatory aminoacids and free radicals.
Experimental data suggest that low temperature decreases the cerebral metabolic rate, and consequently reduces the release of excitatory aminoacids and free radicals.
#TTM2 trial showing no difference in OHCA management with hypothermia (33C) vs. Normothermia (Target 37.5C if temp reach 37.8C or higher).
- Mortality
- mRS
- QoL (EQ-5D-5L)
All no significant difference.
But hypothermia = more arrhythmia (24% vs. 16%)
nejm.org/doi/full/10.10…
- Mortality
- mRS
- QoL (EQ-5D-5L)
All no significant difference.
But hypothermia = more arrhythmia (24% vs. 16%)
nejm.org/doi/full/10.10…
Trying to figure out how to reconcile this with prior data favoring hypothermia? A few points re: TTM2:
- Only stable arrest (>20mins)
- Shockable rhythm >70%
- Average Lactate just below 6
- 54% of patient in normothermia group never had a temp >37.8C (never required cooling)
- Only stable arrest (>20mins)
- Shockable rhythm >70%
- Average Lactate just below 6
- 54% of patient in normothermia group never had a temp >37.8C (never required cooling)
Hyperion trial, which showed a benefit to TTM (33C) vs. Normothermia (37C), had sicker patients.
Even looking at enrollment time: TTM2 enrolled within 180mins in all patients, while Hyperion median enrollment 232.5 + 219mins.
nejm.org/doi/full/10.10…
Even looking at enrollment time: TTM2 enrolled within 180mins in all patients, while Hyperion median enrollment 232.5 + 219mins.
nejm.org/doi/full/10.10…
THREAD and my infographic of the #TTM2 trial
#OHCA patients were randomised to #TTM at 33°C or normothermia (<37.8°C) with early fever treatment.
➡️ Mortality and poor neuro outcome at 6 months were not lower in the hypothermia group.
🔗 nejm.org/doi/full/10.10… #FOAMcc
#OHCA patients were randomised to #TTM at 33°C or normothermia (<37.8°C) with early fever treatment.
➡️ Mortality and poor neuro outcome at 6 months were not lower in the hypothermia group.
🔗 nejm.org/doi/full/10.10… #FOAMcc
Guidelines recommend selecting and maintaining a constant target #TTM between 32 and 36 °C in comatose post-cardiac arrest patients to prevent hypoxic-ischemic brain damage.
(strong recommendation, moderate-quality evidence). #FOAMcc
(strong recommendation, moderate-quality evidence). #FOAMcc
Two RCTs published in 2002 showed an improved survival and neurologic outcome in patients resuscitated from OHCA of presumed cardiac cause and shockable rhythm who underwent hypothermia at 33°C. #FOAMcc
@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas presenting results @ttm2trial now join the livestream #SCCMSoME cochranelibrary.com/cdsr/doi/10.10… Low numbers, lack of certainty hence need for TTM nejm.org/doi/full/10.10… #CHESTTrainees @neurocritical
@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical Variability in evidence, lack of definitive answer for TTM/clinical equipoise @ttm2trial @WICSBottomLine power calculation based on ARR of 7.5, n=1900. Inclusion: Adult, comatose, cardiac arrest-cardiac/unknown; stable ROSC, no ECMO, not asystole, max time from arrest 180 mins
