The Goldilocks of TTM and Potential Exceptions to the Rule

Targeted temperature management (TTM) after cardiac arrest became standard of care after randomized trials illustrated benefits at the turn of the century. Recently, the publication of the largest randomized trial of temperature management, TTM2, has called these data into question. The majority of available evidence, including TTM2, have evaluated TTM after out-of-hospital cardiac arrest (OHCA) due to known or suspected cardiac etiology presenting with a shockable rhythm; however, only 18% of patients with non-traumatic OHCA treated by emergency services present in such fashion. Moreover, OHCA due to other etiologies, like respiratory failure, opioid overdose, metabolic disturbances, and more have often been excluded from these studies. As a result, uncertainty remains regarding the best course of action. This presentation will address knowns and the unknowns of TTM, as well as current recommendations from the International Liaison Committee on Resuscitation.