Thread by @pouyeah

#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…

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)

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…

It seems a reasonable way to reconcile these results is that TTM likely benefits sicker patients more than "healthier" ones. I think @neurologyrules would agree.

...Which makes the job of the #neurointensivist that much harder as the sickest patients, the ones who we are most reluctant to cool, may actually be the ones more likely to benefit. (i.e., unwitnessed, IHCA, etc.)

@neurocritical @SCCM @CritCareExplore @UFHealth @EmoryNeuroCrit