An AHA science advisory based on recent evidence suggests that for resuscitated out-ot-hospital cardiac arrest patients, controlling temperature to less than 37.5° C is a 'reasonable' approach.
The new guidance is based largely on findings from the TTM2 trial, a multicenter, randomized clinical trial of temperature management forafter cardiac arrest that included 1900 unresponsive adult patients successfully resuscitated from OHCA.
No significant between-group difference was seen in the primary outcome of death at 6 months, nor were there any significant differences by subgroups of sex, age, time to return of spontaneous circulation, initial rhythm, or circulatory shock on admission. By contrast, current AHA guidelines endorse targeting a temperature between 32° C and 36° C for 24 hours.
"For the broader group of patients with in-hospital cardiac arrest or OHCA of noncardiac cause, evidence for the ideal approach to temperature management after return of spontaneous circulation is less certain; whether some of these patients might benefit from temperature control at temperatures between 33°C and 37.5°C remains unclear."
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