Targeted Temperature Management is a standard of care, but the nuances of the therapy remain controversial. Before we get into more specific details of targeted temperature management as a therapy, let’s first define it.
Targeted temperature management (or TTM), formally known as therapeutic hypothermia, is a method of actively controlling temperature in a clinical setting. The American Heart Association (AHA) defines TTM as maintaining a patient’s core temperature in the range of 32-36⁰C. However, it can also refer to any active effort to modulate core temperature, whether warming or cooling.
To help illustrate the importance of this method, the AHA and the European Resuscitation Council both recommend TTM in post-resuscitation guidelines, and the World Health Organization recommends actively warming surgical patients as a key method in preventing surgical site infections.
Common clinical scenarios where TTM has been studied include, but are not limited to:
- Ischemic injury, such as post resuscitation from cardiac arrest
- Traumatic brain injury and stroke
- Spinal cord injury
- Cooling kidney donors prior to transplant
It is estimated that each year, 20 million people in the US could benefit from active temperature management, whether preventing inadvertent perioperative hypothermia, maintaining normothermia in neurologically impaired patients, or providing TTM to critically ill patients. All of these are tied to positive health outcomes. However, active temperature management is often underutilized or inadequately applied in many of these situations.
Once you recognize that a patient might benefit from active temperature management, you then need to select a method. “Old school” solutions range from thermal blankets to ice packs to chilled saline bolus, but there are more advanced methods that incorporate servo controls, which allow for automated protocols and patient-specific solutions.
There are several established “advanced” temperature management approaches:
- Intravascular Convection: While effective, these devices rely on the surgical placement of a specialized catheter by a trained physician and need access to a major blood vessel. Post placement, patients face increased risk of Central Line Associated Bloodstream Infection (CLABSI) and thrombosis.
- Surface Convection and Surface Conduction: Both of these approaches require direct contact or close proximity to intact skin. These devices may obstruct patient access and can cause skin damage or even infection.
Currently, there isn’t evidence that one of these methods is substantially better or more effective than the others, so guidelines recommend that clinicians choose a method they are comfortable with and that makes sense in their operational setting.
With modern TTM providers in mind, Attune Medical has introduced a new solution. The EnsoETM simplifies core access by cooling and warming through the esophagus. Click here to learn more.
Michelle Deckard’s “Determining Best Practice for a TTM Post-Arrest Protocol” and Joseph Haymore’s “Normothermia Protocols for the Neurologically Impaired Patient” or download the slides only here.
“Evaluating Your Need for Speed: Timing in TTM” curated by Attune Medical’s Maria Gray, MA, RN and Melissa Naiman, PhD, EMT-B.