Targeted Temperature Management

Excerpt

The use of therapeutic hypothermia is not a new concept; its implementation can be found in literature dating back to the ancient Egyptians. The idea that cooling a person can slow biological processes and subsequently death was first described by Hippocrates (circa 450 B.C), who advised packing wounded soldiers in the snow. In the early 1800s, during the French invasion of Russia, a battlefield surgeon noticed that wounded soldiers placed closer to campfires died sooner than those placed in colder bunks. During this period, cryoanalgesia was also used for amputations, and surgeons noticed that hypothermia not only acted as an analgesic but also slowed bleeding. Clinical interest in the application of therapeutic hypothermia began in the 1930s with case reports on drowning victims who were resuscitated successfully despite prolonged asphyxia.

In 1943, Temple Fay published one of the first scientific papers relating to therapeutic hypothermia. Fay observed improved outcomes after traumatic brain injury (TBI) when temperatures were lowered from 38.3 to 32.7 degrees Celsius. In the 1950s and 1960s, clinical trials using very deep hypothermia were started but abandoned soon after due to adverse effects. In the 1990s, mild hypothermia was implemented in three cardiac arrest cases after successful resuscitation, and all three made a complete recovery without residual neurological damage. Therapeutic hypothermia began getting serious attention after two prospective randomized controlled trials published in the New England Journal of Medicine in 2002 found significant improvements in short and long-term survival, as well as neurological outcomes. Today, the term targeted temperature management (TTM) is used instead of therapeutic hypothermia. TTM can be used to prevent fever, maintain normothermia, or induce hypothermia.