『Keeping It Cool: The Evidence, the Controversy, the Future of TTM with Dr. Andrea Elliott』のカバーアート

Keeping It Cool: The Evidence, the Controversy, the Future of TTM with Dr. Andrea Elliott

Keeping It Cool: The Evidence, the Controversy, the Future of TTM with Dr. Andrea Elliott

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2026年5月12日まで。4か月目以降は月額1,500円で自動更新します。

概要

 In this episode of SoCCC Pre-Rounds, Dr. Balim Senman and Dr. Andrea Elliott, a cardiologist and critical care physician at the University of Minnesota, dive into the evolving landscape of targeted temperature management (TTM) after cardiac arrest. They explore how temperature control strategies have shifted from early hypothermia trials to modern fever-avoidance methods, with ongoing debates around TTM in critical care. Dr. Elliott discusses landmark studies like Bernard, HACA, TTM, Hyperion, and TTM2, highlighting their impact and limitations.The conversation delves into the real-world application of temperature targets, considering patient severity, neurologic injury, and the unique challenges posed by ECPR patients. Dr. Elliott also covers the physiological costs of hypothermia, common complications, and practical aspects of managing shivering, devices, and protocols. Whether you're a trainee or an experienced clinician, this episode offers evidence-based insights and practical guidance for optimizing post-arrest care.TTM is for comatose survivors: Only patients who remain unresponsive after ROSC benefit; awake patients do not.Fever prevention matters most: Trial data on hypothermia vs normothermia are mixed, but fever (>37.7°C) is consistently harmful and must be aggressively avoided.One size does not fit all: Patients with longer downtimes or more severe neurologic injury may benefit more from active cooling. Allowing spontaneous hypothermia is reasonable.ECPR patients are different: Prolonged CPR and ECMO-based temperature control make them physiologically distinct from patients in major TTM trials.[00:00] Introduction[02:16] Historical background of TTM[03:13] Early human studies and mechanisms[04:17] Landmark trials Bernard and HACA[06:06] TM1 Hyperion and TM2 trials[10:25] Patient selection for TTM[11:39] Personalized temperature targeting[13:21] Management of hypothermic and normothermic patients[15:47] TTM in ECPR and ECMO patients[18:09] Drawbacks and risks of hypothermia[19:19] Protocols and cooling devices[21:59] ECPR-specific cooling techniques[16:04] "ECPR patients by definition have had refractory arrest, not attaining ROSC. So that 20- 25 minute time is blown out of the water. Our ECPR population has an average of 60 minutes of CPR time, so more than double. So the time for that neurologic injury is extensive." — Dr. Andrea Elliott[18:43] "You can actually get into trouble if with some under-resuscitation and some patients, if you get them too cold too quickly, and so you'll have to give extra volume back."— Dr. Andrea Elliott[22:37] "The most important thing is to make sure that you avoid fevers in our ECPR patients. We also use cooling towers, so we basically cool the fluid or the blood that is in the tubing outside of the patient so that it goes through a cooling bath."— Dr. Andrea ElliottBecome a member of the Community: https://www.soccc.org/subscribeDr. Andrea Elliotthttps://med.umn.edu/bio/andrea-elliotthttps://www.linkedin.com/in/andrea-elliott-5575b4267/Dr. Balim Senmanhttps://www.linkedin.com/in/balim-senman-7561436b/https://x.com/BalimSenmanMDhttps://www.soccc.org/Supported By:This episode is made possible by unrestricted support from Zoll LifeVest — thanks for keeping high-impact education free for our community.DisclaimerThis podcast is not medical advice, just candid, practical discussions about what your hosts do every day in the CICU. Always consult your supervising team and current guidelines before applying any interventions.
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