Offering the other side their fair say…
Search Results for: TTM2
EMCrit 305 – Post-Cardiac Arrest Hypothermia (or not) – TTM2 Synthesis with Niklas Nielsen and Josef Dankiewicz
The TTM2 trial changes game for post-cardiac arrest management. I am joined today with the study’s authors to discuss this amazing paper.
Neurological Prognostication from the TTM Trial
Neuroprognostication from the TTM Trial Excerpted from Life in the Fast Lane CCC The TTM trial (Nielsen et al, 2013) used a standardized protocol for neurological prognostication to guide decisions regarding treatment withdrawal following targeted temperature management post-cardiac arrest: All patients in the trial were actively treated until a minimum 72 hours after the intervention […]
Five Minutes with Jon Rittenberger on the TTM Trial
More on TTM Trial
EMCrit 126 – TTM Trial Right from Niklas Nielsen’s Mouth
In this episode, I speak with Niklas Nielsen on his thoughts on the TTM trial.
PulmCrit – A history of hypothermia for cardiac arrest, 2002-2021 (RIP)
Let’s start by considering what our pretest probability should be regarding whether hypothermia is beneficial after cardiac arrest. Every enzyme in our body has been evolutionarily designed to function at our normal body temperature. Therefore, hypothermia will affect every chemical pathway. As such, hypothermia is an incredibly blunt tool. It’s hard to think of any […]
EMCrit 74 – Who the Heck to Cool after Cardiac Arrest with Ben Abella
Today we are joined by Benjamin Abella, MD to discuss who to cool after cardiac arrest.
EMCrit 336 – Team NeuroEMCrit’s Critical Neuro Cases – Part 2
SAH and Hypoxic Encephalopathy
IBCC chapter & cast: Post-cardiac arrest management
Post-cardiac arrest management has undergone substantial revisions within the past several years, particularly with regards to temperature management. This remains an area of active controversy and investigation, with the TTM-2 trial currently underway. Although equipoise still exists, this chapter describes a streamlined 36C approach which is based on evidence, guidelines, and experience with various strategies. […]
Post-cardiac arrest management
CONTENTS Rapid Reference 🚀 Cause & investigation Subsequent management: Targeted temperature management (TTM) Shivering management Cardiovascular interventions Pulmonary optimization ID: Aspiration pneumonia & antibiotics Endocrine: steroid Neurologic issues Podcast Questions & discussion Pitfalls investigations ✅ labs Fingerstick glucose. Basic labs (electrolytes including Ca/Mg/Phos, CBC, INR, PTT). Lactate. Troponin. Blood cultures if concern for sepsis. Pregnancy […]
IBCC – Neuroprognostication after cardiac arrest
CONTENTS Rapid Reference 🚀 Introduction Early brain death is (still) death Prognostic value of historical information Confounding factors & hypothermia Timing & serial evaluation Prognostic tests Neurological examination EEG Myoclonus SSEPs (Somatosensory evoked potentials) CT scan MRI Neuron-specific enolase Multimodal prognostication Podcast Questions & discussion Pitfalls PDF of this chapter (or create customized PDF) timing of tests […]
Neuroprognostication after cardiac arrest
CONTENTS Rapid Reference 🚀 Introduction Early brain death is (still) death Prognostic value of historical information Confounding factors & hypothermia Timing & serial evaluation Prognostic tests Neurological examination EEG Myoclonus SSEPs (Somatosensory evoked potentials) CT scan MRI Neuron-specific enolase Multimodal prognostication Podcast Questions & discussion Pitfalls PDF of this chapter (or create customized PDF) timing of tests […]
Neuroprognostication after cardiac arrest
CONTENTS Introduction Early brain death is (still) death Prognostic value of historical information Confounding factors & hypothermia Timing & serial evaluation Prognostic tests Neurological examination EEG EEG background Findings superimposed on the background Myoclonus SSEPs (Somatosensory evoked potentials) CT scan Qualitative CT scan Quantitative CT scan MRI Neuron-specific enolase Multimodal prognostication Related topics Delayed post-hypoxic […]
PulmCrit Wee – Pragmatic comparison of 33C vs. 36C after cardiac arrest
A post last year discussed the top 10 reasons to stop cooling to 33C. It was based largely on the Nielsen trial, which showed similar outcomes between therapeutic hypothermia (TH33) and therapeutic temperature management (TTM36). However, this trial left some questions about how these protocols would perform outside the context of a RCT (external validity). Last year’s post speculated that since TTM36 is easier to achieve, it would out-perform TH33 in real-world conditions.
PulmCrit- Hypothermia for non-shockable arrest: let’s not get hot-headed about this
background Fever is harmful in post-arrest patients. This creates confusion in studies of hypothermia in post-arrest patients: is the benefit of hypothermia due to fever avoidance, due to a benefit from hypothermia itself, or perhaps due to both? Seminal studies in the early 2000s found mortality benefit from application of hypothermia to 33C after cardiac […]