Targeted Temperature Management and Acute Brain Injury: An Update from Recent Clinical Trials

Abstract

The neuroprotective effects of therapeutic hypothermia—increasingly known as targeted temperature management (TTM)—have been recognized for decades, but translation into positive randomized clinical trial outcomes has proved difficult. Although there is level I evidence supporting TTM in adult cardiac arrest and neonatal hypoxic–ischemic encephalopathy, uncertainty remains about optimal temperature targets, exemplified by recent adult cardiac arrest data suggesting that cooling to 36 °C is equally as effective as cooling to 33 °C. For other forms of acute brain injury, the evidence supporting TTM is less clear and, in particular, recent traumatic brain injury trial data were disappointing. Further studies are required to address the logistics of implementing TTM in brain injury, including optimal temperature, timing of onset and duration, and complication management. In addition, further high-quality studies are needed to fully assess the role of TTM in stroke and other forms of acute brain injury.