TTM targeted temperature management at lower temp has higher arrythmia

The patient has developed a new tachyarrhythmia with hemodynamic decompensation during his care after cardiac arrest. The ECG shown here reveals atrial fibrillation with a rapid ventricular response. The development of new tachyarrhythmias in the adult who is critically ill is common and can be influenced by the patient’s underlying conditions, acute illnesses, medications and other treatments, electrolyte abnormalities, and other precipitating factors.

TTM has been a treatment commonly used for the past 2 decades in the care of the survivor of cardiac arrest who is comatose, with the goal of improving survival with good neurologic function by targeting a temperature of 33 °C for at least 24 h after cardiac arrest compared with a normal temperature. Early trials of this intervention suggested possible risks of targeting a temperature of 33 °C to include the development of new pneumonia and electrolyte abnormalities such as hypokalemia, arrhythmia, and bleeding; however, most of these risks were not apparent in larger randomized trials. In the TTM2 trial, the largest trial comparing targeting a temperature of 33 °C vs 37.5 °C, arrhythmia resulting in hemodynamic compromise occurred at a significantly higher rate in patients treated at 33 °C (choice C is correct). In patients treated with TTM, the most common arrhythmias are ventricular tachycardia, followed by severe bradycardia, accelerated nodal rhythm, and atrial fibrillation.12345678

Footnotes

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  8. https://emcrit.org/pulmcrit/top-10-reasons-to-stop-cooling-to-33c/ ↩