Targeted temperature management in neurological intensive care unit

Table 1 Bedside Shivering Assessment Score[69]

0	No shivering
1	Mild: Shivering confines to cervical and/or thorax only
2	Moderate: Shivering extends to whole movement of upper limbs
3	Severe: Shivering spreads to overall movement of trunk, upper limbs and lower limbs

Table 2 Summary of the landmark randomized control trials for targeted temperature management in post-cardiac arrest syndrome

	Australian trial	European trial
Sample size	n = 77	n = 275
TTM vs untreated	43 TTM vs	137 TTM vs
	34 untreated	138 untreated
Initial rhythm	VT/VF	VT/VF
Method of TTM	Surface with ice packs	Surface with cooling blankets/pads and ice packs
Place of initiation	Emergency department	Prehospital setting
Target temperature	33 °C	32 °C-34 °C
Duration of TTM	12 h	24 h
Time of Follow up	30 d	6 mo
Outcomes	NNT of 7 to avoid death	NNT of 6 to improve neurological outcomes

TTM: Targeted temperature management; VF: Ventricular fibrillation; VT: Ventricular tachycardia; NNT: Number-needed-to-treat.

Table 3 Inclusion and exclusion criteria for targeted temperature management after cardiac arrest at Thammasat University Hospital

Inclusion criteria

Witnessed arrest

Any initial rhythm, However initial rhythm VF or pulseless VT is the first priority

Time to ACLS was less than 15 min and total of ACLS time less than 60 min

GCS of 8 or below

SBP of > 90 with or without vasopressors

Less than 8 h have elapsed since ROSC

Exclusion criteria

Pregnancy

Known functional dependence

Down time of > 30 min

ACLS preformed for > 60 min

Known terminal illness

Comatose state prior to cardiac arrest

Prolonged hypotension (i.e., MAP < 60 for > 30 min)

Evidence of hypoxemia for > 15 min following ROSC

Known coagulopathy that cannot be reversed

VF: Ventricular fibrillation; VT: Ventricular tachycardia; ROSC: Restored of systemic circulation.