Post-cardiac arrest care after ROSC (return of spontaneous circulation) includes targeted temperature management (TTM). What is the correct current recommendation for temperature control?

• A Active cooling to 32–34°C for 24 hours in all post-cardiac arrest patients
• B Cooling has no proven benefit post-ROSC and is no longer recommended
• C Therapeutic hypothermia to 28°C for 48 hours provides maximum neuroprotection
• D Avoid fever (temperature >37.7°C); maintain normothermia 36–37.5°C for at least 72 hours; active hypothermia (32–36°C) may be used in comatose survivors of VF arrest based on TTM2 trial evidence ✓

Explanation

The 2021 TTM2 trial (NEJM) found no benefit of 33°C hypothermia over normothermia (37.5°C) in comatose cardiac arrest survivors. Current AHA/ERC 2021 guidelines recommend: for all comatose post-ROSC patients — prevent and treat fever (temperature >37.7°C) aggressively for at least 72 hours. Active cooling to 32–36°C remains a Class IIb recommendation (may be reasonable), especially for VF/pVT arrest. Active hypothermia to 28°C is not recommended and is harmful. Previous guidelines (2010) mandated 32–34°C; this has been updated based on TTM1 and TTM2 evidence.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.