Table 1. Main arguments pro and con for targeted temperature management in non-shockable out-of-hospital cardiac arrest patients.
| Pro TTM (32–36 °C) | Con TTM (avoidance of fever) |
|---|---|
| Pathophysiological rationale and experimental benefits on brain histology, function and survival in animal CA models (10) | No available RCTs in favour of TTM in non-shockable rhythms (11) |
| Human benefits on survival and neurological recovery evidenced in similar clinical settings | Possible TTM-related risks |
| ❖ in overall population of CA patients | ❖ adverse effects (sepsis) (12) |
| ❖ in shockable OHCA patients | ❖ delayed consciousness recovery (13) |
| ❖ in neonatal hypoxic-ischaemic encephalopathy (14) | ❖ prolonged length of stay in ICU |
| ❖ increased costs (13) | |
| Potential benefits outweigh potential TTM-related risks (15) | |
| No alternative available treatment to date | |
| High mortality and burden of comorbidities undermine the ability of RCTs to demonstrate therapeutic benefits |
Conflicting results of non-RCT small sized studies and meta-analyses
TTM, targeted temperature management; CA, cardiac arrest; OHCA, out-of-hospital cardiac arrest; RCTs, randomized controlled studies; ICU, intensive care units.