To evaluate current targeted temperature management (TTM) physician practices and attitudes in post-cardiac arrest care.

Significant practice heterogeneity remains in the application of TTM, despite international guidelines.

We administered a web-based survey via Qualtrics XM to physician members of ºÃÉ«ÏÈÉú (AAN), Neurocritical Care Society (NCS), Society of Critical Care Medicine (SCCM), European Society of Intensive Care Medicine (ESICM), Society of Critical Care Anesthesiologists (SOCCA). The survey contained 45 questions pertaining to respondent demographics and various TTM and post-cardiac arrest management strategies.

As of October 6, 2021, our survey accumulated 412 completed preliminary responses. 92.23% (380/412) of respondents have cared for ≥1 adult post-cardiac arrest patient. Responses were primarily from attendings/consultants (75.00%, 285/380) in the United States (83.42%, 317/380) practicing intensive care medicine (82.10%, 312/380). TTM was used in 93.95% (357/380) of respondents’ primary hospital of practice and 96.92% (346/357) claimed to have started TTM in the past. The most common reasons for initiation of TTM were recommendation by national/international guidelines (78.90%, 273/346) and to optimize chance of neurologic recovery (78.03%, 270/346). The most selected target temperatures were 36°C (49.58%, 177/357) and 33°C (32-34°C) (40.34%, 144/357). Closed-loop surface device was the preferred method of cooling (85.15%, 304/357). Among respondents who were aware of the TTM2 trial (82.35%, 294/357), but did not change their practice of TTM (56.46%, 166/294), knowledge of conflicting data limited incorporation of the trial results into practice (41.57%, 69/166). Respondents who were aware of the trial (82.35%, 294/357) and did change their practice of TTM/TH (43.54%, 128/294) now target normothermia (<37.5°C) rather than hypothermia (<36°C) (93.75%, 120/128). 

Our results demonstrate that heterogeneity exists in post-cardiac arrest TTM management. The recent TTM2 trial failed to change many physicians’ practice of TTM, indicating the heterogenous interpretations of current TTM data and literature.