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Date of Award

Spring 2021

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Zachary Weik

Abstract

Introduction: Targeted temperature management (TTM) had been shown to limit neurological damage that is incurred in the post- cardiac arrest period. However, the temperature at which neurologic protection is greatest is still unknown. This review analyzes mortality rates and neurologic outcomes of groups treated with TTM at 36°C vs TTM at 32°C- 34°C.

Methods: A literature search was conducted in November 2019 in the PubMed and Ovid databases. A total of six articles, randomized controlled trials and retrospective studies, were selected based on relevance to the research question, study design and population demographics.

Results: An analysis of the articles revealed that there was no statistically significant difference in mortality or neurologic function between the 32°C- 34°C group and the 36°C group in all studies that investigated these outcomes. Other studies also measured adverse events that occurred during treatment and found that the 36°C groups had lower rates of shivering, fever and severe bleeding.

Discussion: Most studies found no difference between the 32°C- 34°C and the 36°C groups in regard to mortality and neurologic outcomes. The majority of the studies used the Cerebral Performance Category (CPC) as the form of measurement for neurologic functioning, and this review found congruency in results across studies using this method. Other studies used different rating scales that cannot be compared but showed similar outcomes in relation to neurologic functioning.

Conclusion: TTM at 36°C should be considered an equally valid treatment as it pertains to neurologic outcomes in patients experiencing OHCA when compared to TTM at 32°C- 34°C. Further research should consider the adverse events, effects on other body systems, long term outcomes and feasibility of obtaining and sustaining a temperature of 36°C.

Additional Files

Mennillo Capstone Reference.docx (14 kB)
Reference

Mennillo, Ashley Poster Presentation.pdf (13034 kB)
Poster Presentation

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Targeted Temperature Management at 36°C in the treatment of out- of- hospital cardiac arrest

Introduction: Targeted temperature management (TTM) had been shown to limit neurological damage that is incurred in the post- cardiac arrest period. However, the temperature at which neurologic protection is greatest is still unknown. This review analyzes mortality rates and neurologic outcomes of groups treated with TTM at 36°C vs TTM at 32°C- 34°C.

Methods: A literature search was conducted in November 2019 in the PubMed and Ovid databases. A total of six articles, randomized controlled trials and retrospective studies, were selected based on relevance to the research question, study design and population demographics.

Results: An analysis of the articles revealed that there was no statistically significant difference in mortality or neurologic function between the 32°C- 34°C group and the 36°C group in all studies that investigated these outcomes. Other studies also measured adverse events that occurred during treatment and found that the 36°C groups had lower rates of shivering, fever and severe bleeding.

Discussion: Most studies found no difference between the 32°C- 34°C and the 36°C groups in regard to mortality and neurologic outcomes. The majority of the studies used the Cerebral Performance Category (CPC) as the form of measurement for neurologic functioning, and this review found congruency in results across studies using this method. Other studies used different rating scales that cannot be compared but showed similar outcomes in relation to neurologic functioning.

Conclusion: TTM at 36°C should be considered an equally valid treatment as it pertains to neurologic outcomes in patients experiencing OHCA when compared to TTM at 32°C- 34°C. Further research should consider the adverse events, effects on other body systems, long term outcomes and feasibility of obtaining and sustaining a temperature of 36°C.