Translating Targeted Temperature Management Trials into Postarrest Care

This editorial explores the clinical implications of the TTM and TTM2 trials evaluating targeted temperature management (TTM) in post–cardiac arrest care. Both trials found no significant survival difference between hypothermia (33℃) and normothermia (~36–37.5℃), yet demonstrated that structured TTM protocols including device-assisted cooling, sedation, and close temperature monitoring led to survival rates near 50%, far exceeding historical averages. The authors caution against misinterpreting these results as negating the value of TTM. Instead, they stress that such protocols are essential, regardless of target temperature. The editorial warns against premature cessation of life-sustaining therapies based on perceived prognosis and endorses expert-guided neurologic assessment. It also advocates for personalized TTM targets based on brain injury severity, and urges continued research in special populations (e.g., overdose, drowning). Finally, the authors call for patient-centered approaches and quality improvement efforts to ensure consistent implementation of TTM best practices.

This editorial explores the clinical implications of the TTM and TTM2 trials evaluating targeted temperature management (TTM) in post–cardiac arrest care. Both trials found no significant survival difference between hypothermia (33℃) and normothermia (~36–37.5℃), yet demonstrated that structured TTM protocols including device-assisted cooling, sedation, and close temperature monitoring led to survival rates near 50%, far exceeding historical averages. The authors caution against misinterpreting these results as negating the value of TTM. Instead, they stress that such protocols are essential, regardless of target temperature. The editorial warns against premature cessation of life-sustaining therapies based on perceived prognosis and endorses expert-guided neurologic assessment. It also advocates for personalized TTM targets based on brain injury severity, and urges continued research in special populations (e.g., overdose, drowning). Finally, the authors call for patient-centered approaches and quality improvement efforts to ensure consistent implementation of TTM best practices.