Which cooling procedures are used in targeted temperature management (TTM)?

Updated: Jul 26, 2019
  • Author: Alex Koyfman, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

Answer

Cooling must be performed rapidly to achieve maximum effectiveness and should be instituted as early as possible. Most studies have found it necessary to use both cooling blankets and ice packs to achieve the temperature goal. Other methods such as ice lavage, cold saline infusion, and endovascular methods may be used to help achieve target temperature.

  • Do not actively rewarm patients who are spontaneously hypothermic.

  • When possible, hypothermia therapy for patients with out-of-hospital cardiac arrest should be initiated in the emergency department. Treatment can be continued while in the percutaneous coronary intervention (PCI) laboratory and in the intensive care unit (ICU).

  • Place an arterial line early for blood pressure monitoring as peripheral vasoconstriction will increase the difficulty of placing the line after the patient is cooled.

  • A continuous core temperature monitor should be used; this provides data to modulate cooling efforts and to avoid overcooling.

  • Esophageal, rectal, or bladder temperature is used to monitor the temperature.

  • Several cooling systems including liquid or gel heat transfer and endovascular systems incorporate a temperature probe (rectal, bladder, or attached to the endovascular coil system) that provides feedback to modulate the amount of cooling provided.

  • A pulmonary artery temperature probe may be used, if available.

  • A secondary temperature device should be used to monitor temperature as well. A bladder probe is only accurate when urine output is adequate; therefore, an alternative to the bladder temperature probe is required in the setting of oliguria. This alternative temperature probe can be any core temperature monitor (eg, esophageal).


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