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Post-cardiac Arrest Temperature Management — EECC MCQ

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ModerateGeneral CardiologyPost-cardiac Arrest Temperature ManagementEECC

A 55-year-old man is resuscitated from out-of-hospital cardiac arrest (initial rhythm VF). ROSC is achieved after 20 minutes of CPR. He is intubated and unresponsive (GCS 3). His coronary angiogram shows an acute LAD occlusion which is treated with primary PCI. What is the recommended target temperature management (TTM) strategy?

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Correct answer: E — Target temperature of 32-36°C maintained for at least 24 hours, followed by controlled rewarming and avoidance of fever for 72 hours

The TTM2 trial showed no difference in mortality between targeted temperature of 33°C vs normothermia (≤37.5°C with active prevention of fever), leading to a broader recommended range of 32-36°C. The key is to actively prevent fever (>37.7°C) for at least 72 hours post-ROSC, as fever worsens neurological outcomes. The European Resuscitation Council (ERC) and ESC guidelines recommend maintaining a target temperature of 32-36°C for at least 24 hours in comatose patients post-cardiac arrest, regardless of the initial rhythm (shockable or non-shockable). Controlled rewarming at 0.25-0.5°C per hour follows the hypothermia period. Neuroprognostication should not be performed until ≥72 hours after rewarming.

Reference: ERC (2021): Post-Resuscitation Care Guidelines; ESC (2023): ACS Guidelines