In this episode, I speak with Niklas Nielsen on his thoughts on the TTM trial.
Coverage of the TTM Trial
Kee Polderman's Editorial
Update
My theory on goal temp 33 causing a hibernation response was born out by
A. Lybeck, T. Cronberg, A. Aneman, et al.Time to awakening after cardiac arrest and the association with target temperature management
Resuscitation, 126 (2018), pp. 166-171
Additional New Information
More on EMCrit
- Top 10 reasons to stop cooling to 33C(Opens in a new browser tab)
- Five Minutes with Jon Rittenberger on the TTM Trial(Opens in a new browser tab)
- EMCrit Wee – The Targeted Temperature Trial Changes Everything(Opens in a new browser tab)
- Neurological Prognostication from the TTM Trial(Opens in a new browser tab)
- Neurological Prognostication from the TTM Trial(Opens in a new browser tab)
Additional Resources
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Great podcast. No mention though of David Seder’s rebuttal from the neurocritical care conference. I still think there might be something there… in short, treating people with more severe brain injury (by whatever measure you use) with 33. As a cardiologist, my analogy is to ICD. If you had a clinical trial where all people with new heart failure EF 30% were randomized to ICD or no ICD at day zero, it may show no difference. You have to treat the subgroup who’s EF didn’t get better after their ischemia was treated with PCI, and those who get better with… Read more »
the debate will be posted on the site and then we can do an emcritters straw poll
Scott, Thanks so much for doing this, it really has helped answer many of my personal questions and address the concerns issued by the by Dr. Polderman. Despite this, many clinicians seem very resistant to change their targeted temperature after this trial, despite widespread adoption of hypothermia after 2 small RCTs totaling only 300ish patients. This was an excellent study which most everyone agrees on, there was no signal of difference between the two arms (ALL point estimates of benefit favored the 36 group over the 33 group). The St Emlyn’s blog mentions that the ARR varies from 5.4% in… Read more »
yep, ECMO is the ?. Bleeds vs. the desirable lowering of metabolic demand. Need/want a study…