Temperature Control in Hypoxic-Ischemic Brain Injury-a Focused Update

Purpose of Review Targeted temperature management (TTM) has been the mainstay of secondary brain injury prevention for unconscious cardiac arrest survivors. In this ever-changing landscape of post-cardiac arrest care, TTM practices are evolving with emergence of new evidence. We discuss the pre-clinical data paving the scientific premise for temperature control in hypoxic-ischemic brain injury and dissect through landmark TTM trials. We then describe how the practice of TTM has changed in response to the most pivotal trials and discuss exciting topics that are under investigation. Recent Findings The advent of TTM2 has challenged the use of lower temperature targets in out-of-hospital cardiac arrest of presumed cardiac etiology by finding similar survival and neurological function at 6 months between cooling post-arrest patients to 33 degrees C for 24 h (followed by gradual rewarming and targeted normothermia) and actively preventing fever (< 37.8 degrees C) for 72 h. Temperature control remains the cornerstone in secondary brain injury prevention post-cardiac arrest, and practices surrounding temperature targets are evolving over time as new evidence emerges. Future studies on tailored temperature control to individualized factors, including depth and duration, as well as rate of rewarming will be crucial to address prevailing knowledge gaps.