What should be avoided in TTM?

Contraindications for Targeted Temperature Management (TTM) include absolute issues like intracranial bleeding, severe sepsis, active major bleeding (especially traumatic), and severe hemodynamic instability (uncontrolled shock/hypotension). Relative contraindications involve conditions like pregnancy, recent major surgery, significant coagulopathy, DNR orders, terminal illness, or a poor baseline mental status (GCS > 8), where careful consideration is needed, potentially with modified cooling to normothermia (36°C).

What are the contraindications for TTM?

Contraindications to the initiation of TTM include uncontrolled bleeding, refractory shock, and severe infections.

What are the do's and don'ts of hyperthermia?

Seek immediate medical attention. Bystanders may need to help you by moving you out of the heat and using any available means to cool you down. Don't drink any fluids (you may inhale them, which is dangerous). Don't take any fever-reducing medications (they won't help and may worsen complications).

What are the recommendations for TTM?

We recommend that comatose adult patients with ROSC after cardiac arrest have TTM between 32-36o Celsius.

What are three key elements of the TTM protocol?

There are three distinct phases of TTM: induction, maintenance, and rewarming.

• Induction. The induction phase of TTM is initiated as soon as possible after ROSC. ...
• Maintenance. Once reaching the target TTM temperature, clinicians must maintain that temperature carefully. ...
• Rewarming.

Targeted Temperature Management (TTM) - Therapeutic Hypothermia - Hypothermia Protocol

What are the contraindications for therapeutic hypothermia?

Contraindications. There are few true contraindications for TH. Medical conditions in which the risk may be excessive include documented intracranial hemorrhage, severe hemorrhage leading to exsanguination, hypotension refractory to multiple vasopressors, severe sepsis, and pregnancy.

What are the risks of TTM?

Risk and complications

TTM may lead to fluid and electrolyte imbalances, arrhythmias, insulin resistance, shivering, coagulation problems, pancreatitis, infection, skin breakdown and other adverse effects.

When to stop TTM?

Duration of TTM and rewarming

TTM should be induced and maintained at the selected target temperature for 24 hours, and rewarmed gradually at a rate not faster than 0.5°C per hour. Every hour of delay in TTM after ROSC increases mortality by 20%. Thus, TTM should be initiated as soon as possible after ROSC.

What are the methods of TTM in ACLS?

(TTM) Targeted Temperature Management

One of the most common methods used for inducing therapeutic hypothermia is a rapid infusion of ice-cold (4° C), isotonic, non-glucose-containing fluid to a volume of 30 ml/kg. The optimum temperature for therapeutic hypothermia is 32-36 ° C (89.6 to 96.8 ° F).

What is a TTM procedure?

Targeted temperature management is used during open-heart surgery because it decreases the metabolic needs of the brain, heart, and other organs, reducing the risk of damage to them. The patient is given medication to prevent shivering. The body is then cooled to 25–32 °C (77–90 °F).

What 5 things help in the prevention of hyperthermia?

Tips for Preventing Heat-Related Illness

• Get Plenty to Drink. Sweating removes needed salt and minerals from the body. ...
• Stay Cool Indoors. The best way to beat the heat is to stay in an air conditioned area. ...
• Wear Light Clothing and Sunscreen. ...
• ​​Schedule Outdoor Activities Carefully. ...
• Pace Yourself. ...
• Use a Buddy System.

What are the two things you should never do to a patient who is in hypothermia?

What to avoid

• Do not rewarm the person too quickly, such as with a heating lamp or hot bath.
• Don't attempt to warm the arms and legs. Heating or massaging the limbs can stress the heart and lungs.
• Don't give the person alcohol or cigarettes.

What are 5 signs of hyperthermia?

Five key symptoms of hyperthermia (heat illness) include heavy sweating, headache, nausea/vomiting, dizziness/weakness, and a high body temperature, though severe cases can involve confusion, rapid pulse, or even seizures. These symptoms signal your body is struggling to cool down, ranging from heat exhaustion to life-threatening heatstroke, requiring prompt action.
 

What is the goal temperature for TTM?

The goal is to achieve a core temperature of 32 to 34 degrees Celsius as soon as possible, maintain this temperature for 12 to 24 hours, and then rewarm at a controlled rate of 0.2 to 0.5 C/hour.

What medical conditions use TTM?

TTM is effective in five primary categories of medical events:

• Neonatal encephalopathy.
• Cardiac arrest.
• Ischemic stroke.
• Traumatic brain or spinal cord injury without a fever.
• Neurogenic fever following brain trauma.

What are the AHA guidelines for TTM?

Current American Heart Association guidelines endorse treating unresponsive adult patients with cardiac arrest, regardless of location of arrest, with temperature management targeting a temperature between 32° C and 36° C for 24 hours of therapy.

When is TTM contraindicated?

There are also contraindications for TTM, including coagulopathy, sepsis, hemodynamic instability, hemorrhagic stroke, and uncontrolled bleeding. Therapeutic hypothermia is additionally contraindicated in cardiac arrest caused by trauma.

What are the 5 T's in ACLS?

The 5 T's in Advanced Cardiovascular Life Support (ACLS) are reversible causes of cardiac arrest: Tension Pneumothorax, Tamponade (Cardiac), Toxins, Thrombosis (Pulmonary), and Thrombosis (Coronary/Heart Attack), which must be identified and treated alongside standard CPR to improve patient survival. They are part of the larger "H's and T's" mnemonic for addressing treatable underlying issues during resuscitation.
 

What are the current TTM guidelines?

TTM: constant temperature of 32-36°C for ≥ 24 hours; then prevent fever in the following 24 hours to 48 hours post-ROSC.

How to treat shivering with TTM?

We recommend a tiered protocol to prevent and treat shiver. Patients who are started on TTM should have an appropriate antipyretic agent (acetaminophen or NSAID) given every 4 to 6 hours around the clock. Standing doses of buspirone (30 mg) should be given every 8 hours.

Is TTM used for stroke patients?

TTM is a recommended neuroprotective intervention for all comatose/unresponsive survivors of cardiac arrest, regardless of the initial rhythm or arrest location (19). Several studies have reported that early initiation of TTM within a few hours of ischemic stroke is associated with favorable outcomes (9).

What is the rewarming phase of TTM?

Phase 3: Re-warming (re-warm to 37.5°C):

At 24 hours (from when patient has reached goal temp), begin re-warming to 37.5°C at 0.3°C/hr using the surface cooling device.

What is an absolute contraindication to targeted temperature management of therapeutic hypothermia?

Further, they recommend selecting and maintaining a constant temperature between 32 degrees C and 36 degrees C during TTM. Absolute contraindications to TTM are an awake and responsive patient, DNR, active non-compressible bleeding and the need for immediate surgery.

What is TTM in ACLS?

Targeted temperature management (TTM), previously known as mild therapeutic hypothermia, in selected patients surviving out-of-hospital sudden cardiac arrest (OHCA) can significantly improve rates of long-term neurologically intact survival, and it may prove to be one of the most important clinical advancements in the ...

How long is TTM duration?

Importance International resuscitation guidelines recommend targeted temperature management (TTM) at 33°C to 36°C in unconscious patients with out-of-hospital cardiac arrest for at least 24 hours, but the optimal duration of TTM is uncertain.