Brain freezeNov 19th, 2013: Now that was a crushing publication… On Nov 17th, 2013 NEJM published the results of an international trial (TTM trial) with 950 patient’s which assassinated the concept of therapeutic hypothermia? The study group concluded that „in unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C„.

Therapeutic hypothermia industry must be shivering in fear… Who is going to buy any thermo-suits and likewise devices if all you need is 36 degrees Celsius?

Not a single conscious person likes to shiver… That „brain freeze ache” you get when eating your ice-cream too fast doesn’t feel good at all… Why would those benefit the unconscious? Well, it doesn’t seem like they do! Not that fever does them any good either – golden middle way works best! Who would have thought? 😉

MERITUS

Dec 2nd, 2013: On the website of University of Pennsylvania, Perelman School of Medicine, Dr. Benjamin Abella from Center for Resuscitation Science posted a video as commentary to the Targeted Temperature Trial TTM trial. Nice try at rescuing the therapeutic hypothermia industry – so it seems :-( His ties to this business are quite overwhelming! Still referred to as „potential” conflict of interest – interesting concept, isn’t it?

Aside from my major industrial reservations, in response to Dr. Abella, I’d say:

  1. Nowhere does TTM trial suggest that temeprature management after cardiac arrest is irrelevant – it just shows there is no need to brain freeze the patients after ROSC.
  2. As mentioned above, common sense is enough to conclude that hyperthermia is not a good option – maintain your patients at low normal 36 degrees Celsius.
  3. In 2002 the HACA trial and Bernard et al. only compared hypothermia with relative hyperthermia. TTM trial filled in the gap and showed that low normothermia is just as good.
  4. Dr. Abella raised a concern that in TTM trial 73% of patients received bystander CPR – as opposed to Philly? – I guess if you are doomed to have a cardiac arrest make sure it’s not in Philly – probably best on your European vacation? 😉
It looks like spending money on fancy hypothermia equipment will no longer provide a lucrative return on investment. You are better off investing in bystander education… Don’t we all say that immediate effective CPR is what makes the biggest difference?