The Podcast entitled “Temperature Management Matters: Past, Present and Future” with Dr. Nickolas Johnson, Associate Professor, University of Washington focused on lessons learned from past clinical trials in cardiac arrest and next steps for improving TTM protocols. In addition to reviewing published results from the completed TTM1 and TTM2 trials, Dr. Johnson discussed the new ICECAP trial that will use an innovative adaptive randomization approach to clarify the optimal duration of cooling associated with best outcomes in post cardiac patients. Consistent with the concept of specialized medicine, these types of clinical studies and resulting data could result in new guidelines for the use of temperature management protocols in terms of cooling duration in this heterogenous population of patients.

Episode #1: Temperature Management Matters: Past, Present and Future

The Podcast entitled “During TTM, What Matters Most” with Dr. Justin Lundbye, Chief Medical Officer, Waterbury Hospital, CT discussed topics critical to the successful use of TTM including speed of cooling and reaching and maintaining consistent temperature levels during the treatment phase. Important lessons learned for successfully treating fever by proactively initiating preventive measures such as placing patients on TTM protocols were highlighted. In addition to using intravascular and surface cooling approaches to reduce fever burden, several medications are available to help prevent or limit the severity and duration and elevated core temperatures. As we continue to focus of optimal levels and durations of TTM treatment, the importance of elevated core temperatures on patient outcomes remains a serious issue and requires proactive measures to limit detrimental consequences.

Episode #2  During TTM, What Matters Most

The Podcast entitled “High-Quality TTM Matters to Hospitals” with Michael Kurz, MD, Associate Professor Department of Emergency Medicine, Co-Director Therapeutic Hypothermia Program at the University of Alabama Birmingham, and David Hildebrandt, BSN, MBA, Associate Director, of Clinical Operations at the Smidt Heart Institute, Cedars-Sinai Medical Center discussed their perspectives on clinical care from the nurse and physician perspective. The importance of implementing fully vetted TTM standard operating procedures supported by nurses and physicians was emphasized. This step was felt to be critical since TTM procedures are commonly conducted in parallel with other monitoring and treatment protocols to maximize patient recovery. The importance of different cooling techniques like surface and intravascular approaches on efficiency and nurse burden was also discussed. It’s important to emphasize that the use of automated TTM methods in emergency rooms and intensive care units have led to improved patient outcomes, reduced staff burden and cost savings for hospitals. Future research is required to determine more effective ways to personalize these TTM protocols to individuals based on injury severity and other relevant factors using surrogate biomarker platforms and other approaches.

Episode #3  High - Quality TTM Matters To Hospitals

The Podcast entitled “Early Induction of Temperature Management” with Dr. Wilhelm Behringer, Professor and Chair, Department of Emergency Medicine, University Hospital Vienna discussed several topics related to the use of TH in cardiac arrest patients. Dr. Behringer first talked about his systemic review of cardiac arrest animal studies that reported a consistent favorable effect of TTM versus normothermia. Next a recent Letter to the Editor submitted by Dr. Behringer and colleagues reviewed the results of a recent meta-analysis by Granfeldt and colleagues in Resuscitation. The letter emphasized 2 limitations from that analysis including the approach of splitting the evaluations at 2 different outcome assessments and the inclusion of a specific study that increased the clinical heterogeneity of the analyzed data sets. This issue of patient heterogeneity led to an interesting discussion on how best to possibly stratify the patient populations to temperature dose and the fact that “one size fits all” is not appropriate when treating these patients. Finally, the importance of early cooling and the possible advantages of initiating cooling earlier and continuing the cooling treatment with a feedback cooling system to ensure consistent levels of hypothermia were emphasized.

Episode #4 Early Induction Of Temperature Management

The podcast entitled “Why Do I Use Targeted Temperature Management” with Dr. Brian O’Neil, Processor and Chair, Department of Emergency Medicine, Wayne State University School of Medicine and Dr. Bernd Böttiger, Professor and Head, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne covered several topics on the practical use of TTM in daily practice. Current TTM guidelines in the US and in Germany were cited as well as challenges including a restrictive therapeutic window for therapeutic hypothermia. The issue of patient heterogeneity in out-of-hospital cardiac arrest patients and the possible benefits for new biomarkers to identify patients that would benefit from this neuroprotective treatment were summarized. The effective management of TTM including the importance of bystander cardiopulmonary resuscitation rates, cooling methods and the need for early cooling at lower levels (33°C) were also highlighted during this interesting discussion.

Episode #5  Why Do I Use Target Temperature Management

The podcast entitled “The Importance of Fever Prevention in Clinical Practice” with Dr. Shahed Toossi, Assistant Professor of Neurology and Neurological Surgery, Cedars Sinai Medical Center and Dr. Rainer Lenhardt, Professor and Vice Chair for Clinical Affairs, Department of Anesthesiology and Perioperative Medicine, University of Louisville covered several important topics. The occurrence of fever in clinical practice and mechanisms underlying postinjury temperature elevations were discussed. Also, whether or not the clinical literature had convincingly demonstrated whether preventing fever actually improved clinical outcomes was also debated. Issues regarding specific patient populations where prophylactic fever avoidance might be most effective and the significance of the recent TTM2 trial for cardiac arrest where targeted normothermia (37.8oC) was directly compared to targeted hypothermia (33oC) was mentioned. There are multiple strategies for preventing and treating periods of fever and the advantages of these approaches were discussed. The issue of patient heterogeneity in clinical trials was emphasized and the goals of the ICECAP trial where optimal durations of hypothermia treatment are being evaluated was discussed. This rich discussion generated several unanswered questions again emphasizing the continued interest in this experimental treatment strategy and the need for additional research.

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