Table 1 Differences in detailed targeted temperature management protocol between guidelines and randomized controlled trials
Authors (published year) | Target temperature | Timing of initiation | Time to target temperature | Cooling techniques | Treatment duration | Sedatives | Neuromuscular blockades | Rewarming methods | Management after rewarming |
|---|---|---|---|---|---|---|---|---|---|
HACA Study Group 2002 [3] | 32–34 °C | After ROSC at hospital | Within 4 h after ROSC | External cooling device (TheraKool®) (if the goal was not achieved, ice packs were applied | 24 h from cooling | Midazolam (0.125 mg/kg/h) and fentanyl (0.002 mg/kg/h) for 32 h | Pancuronium (0.1 mg/kg) every 2 h for a total of 32 h | Passive rewarming (over a period of 8 h) | / |
Bernard, et al. 2002 [4] | 33 °C | After ROSC in the ambulance | / | Ice packs (Coolcare®) | 12 h after hospital arrival | Midazolam (2–5 mg) for 24 h | Vecronium (8–12 mg) for 24 h | Beginning at 18 h, actively rewarmed for the next 6 h by external warming with a heated-air blanket | Usual intensive care |
CoSTR from ILCOR 2010 [1, 2] Guidelines from AHA, ERC 2010 [18, 19] | 32–34 °C | Minutes to hours after ROSC | / | No single methods has proved to be optimal | 12–24 h | / | / | / | Late hyperthermia (after rewarming post-hypothermia) should be identified and treated |
Nielsen, et al. 2013 [7] | 33 °C | After randomization at hospital, after ROSC | As rapidly as possible | Ice-cold fluids, ice packs, and intravascular or surface temperature-management devices at the discretions of the sites | 28 h after randomization | Mandated until the end of the intervention period (36 h) | / | After 28 h, gradual rewarming to 37 °C (0.5 °C/h) | For unconscious patients below 37.5 °C until 72 h after cardiac arrest, with the use of fever control measures at the discretion of the sites |