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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the final results from the Target Temperature Management After Cardiac Arrest trial [TTM; Nielsen N et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2013], which demonstrated that therapeutic cooling to a lower-temperature target does not improve outcomes of unconscious survivors of out-of-hospital cardiac arrest compared with cooling to standard temperature targets.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ENiklas Nielsen, MD, PhD, EDIC, DEAA, Helsingborg Hospital, Lund University, Helsingborg, Sweden, presented the final results from the Target Temperature Management After Cardiac Arrest trial [TTM; Nielsen N et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2013], which demonstrated that therapeutic cooling to a lower-temperature target does not improve outcomes of unconscious survivors of out-of-hospital cardiac arrest (OHCA) compared with cooling to standard temperature targets.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EOHCA carries a high risk of death and poor neurological outcomes. Since induced hypothermia is associated with improved outcomes in these patients, its use is recommended in clinical guidelines. However, the optimal target temperature is unknown [Nielsen N et al. \u003Cem\u003EInt J Cardiol\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe TTM trial [Nielsen N et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2013] is the largest trial to study hypothermia in cardiac arrest patients. This international, multicenter, randomized trial was designed to evaluate whether cooling to a target temperature of 33\u00b0C compared with 36\u00b0C improved outcome in patients with OHCA.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EInclusion criteria were OHCA, age \u226518 years, unconscious, presumed cardiac cause, and stable return of spontaneous circulation (ROSC).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EExclusion criteria included unwitnessed cardiac arrest with initial rhythm of asystole, ROSC to screening interval \u0026gt;240 minutes, known or suspected acute intracranial hemorrhage or stroke, and body temperature \u0026lt;30\u00b0C.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe primary endpoint of the study was all-cause mortality through the end of the trial, and the main secondary outcome was a composite of death or poor neurologic function at 180 days, as evaluated by the Cerebral Performance Category scale and modified Rankin scale.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EA total of 939 OHCA patients were enrolled in the study and randomized 1:1 to either target temperature managements of 33\u00b0C (n=473) or 36\u00b0C (n=466) for 24 hours.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EAt the end of the trial, there was no significant difference in the primary endpoint of patient mortality between the 33\u00b0C and 36\u00b0C groups (50% vs 48%; p=0.51).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EAnd similarly, at 180-day follow-up, there was no significant difference in the percentage of patients who had died or had poor neurologic function, as evaluated with either the Cerebral Performance Category scale (54% vs 52%; p=0.78), or the modified Rankin scale (both 52%; p=0.87).\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003ESerious adverse events, including bleeding, pneumonia, and electrolyte disturbances, were frequent in both the 33\u00b0C group and the 36\u00b0C group (93% vs 90%; p=0.09), with a significant increase in the incidence of hypokalemia (19% vs 13%; p=0.02)\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EProf. Nielsen concluded that these results do not suggest any benefit for a target body temperature of 33\u00b0C in unconscious OHCA patients compared with 36\u00b0C. The optimal temperature for therapeutic hypothermia in this patient population therefore remains unclear, and further study is needed to determine the optimal temperature goal for patients with OHCA being treated with therapeutic hypothermia.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/20\/14.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznjlq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}