Date of Award
Master of Physician Assistant Studies (MPAS)
Physician Assistant Studies
targeted temperature management; neurological functioning; survivability; cognitive function; resuscitation
Novel methods of ensuring survival following cardiac arrest and resuscitation are of supreme importance to the medical community. Targeted temperature management (TTM) has become increasingly utilized pre-hospital, in emergency departments, and within intensive care units to increase the likelihood of survival to hospital discharge. TTM has further been used to attempt to improve neurological functioning. The efficacy and mechanism behind TTM remains poorly understood. In several patient populations it also remains unproven. The purpose of this study is to assess the physiological mechanism, survival, neurological recovery and methodology of TTM use and implementation.
Literature review was utilized to assess the physiological mechanism by which TTM elicits its neuroprotective effects. Statistics on neurological outcomes and survival rates were further examined. Finally, the proposed method to safely and efficiently induce and maintain TTM in appropriate patients was also assessed through literature review.
TTM was found to improve survival and neurological functioning in adults suffering cardiac arrest both in-hospital and out-of-hospital. No improvement has been noted in studies on pediatric patients, thus TTM is not indicated in pediatric patients. Animal studies demonstrate a decrease in cerebral edema and mitochondrial apoptosis of neuronal cells with TTM application. Serum biomarkers of brain injury and disfunction of the endothelial lining constituting the brain blood barrier (BBB) have also been found to be decreased in patients undergoing TTM. Finally, serum assay of antioxidants demonstrates a decrease in oxidative damage and increase in antioxidant protection following reperfusion.
Hovde, Timothy, "The Neuroprotective Effects of Targeted Temperature Management on Post-Cardiac Arrest Patients" (2018). Physician Assistant Scholarly Project Papers. 14.