Targeted temperature management (TTM) is recommended after resuscitation from cardiac arrest. According to the TTM2 trial (2021) and current guidelines, which temperature target and duration are appropriate?
- A Core temperature 32–34°C for 72 hours
- B Core temperature 35–36°C for 24 hours only
- C Core temperature prevented from reaching fever (>37.5°C) for at least 72 hours; strict 33°C TTM not superior to normothermia prevention ✓
- D Core temperature 36–37°C for 48 hours with antipyretics only
Explanation
The TTM2 trial (2021, NEJM) compared targeted hypothermia (33°C for 28 hours) with normothermia (fever prevention, avoiding core temperature >37.8°C) in 1900 patients after out-of-hospital cardiac arrest, and found no significant difference in 6-month mortality or neurological outcomes. Current ILCOR/AHA 2023 guidance supports preventing fever (>37.5–38°C) for at least 72 hours after ROSC in comatose survivors, as the clear benefit of active cooling to 33°C is no longer supported. Patients should be kept consistently normothermic; fever is independently associated with worse neurological outcomes.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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