Targeted Temperature Management Post-Cardiac Arrest: Shifting Paradigms from Hypothermia to Strict Normothermia and its Impact on Neurological Prognostication
DOI:
https://doi.org/10.12775/QS.2026.55.71174Keywords
cardiac arrest, targeted temperature management, normothermia, hypothermia, neuroprognostication, post-cardiac arrest syndromeAbstract
Background. Cardiac arrest (CA) remains a major global health challenge with high risk of severe neurological impairment. Post-cardiac arrest syndrome (PCAS), particularly hypoxic-ischemic brain injury, drives mortality and long-term disability. Targeted temperature management (TTM), traditionally a neuroprotective cornerstone, is currently being re-evaluated.
Aim. To analyze current evidence on post-CA temperature management, focusing on the shift from therapeutic hypothermia to strict normothermia and its implications for neurological prognostication.
Materials and methods. This narrative review synthesizes 30 peer-reviewed publications, including randomized trials, systematic reviews, and international guidelines (ERC, ESICM, NCS). It evaluates PCAS pathophysiology, hypothermia versus normothermia outcomes, technical TTM implementation, and multimodal neuroprognostication.
Results. Recent high-quality evidence shows no significant benefit of routine therapeutic hypothermia (32–34°C) over strict normothermia in improving survival or neurological outcomes. Guidelines now emphasize active fever prevention (≤37.5°C) using precise control systems. While TTM modulates systemic inflammation (e.g., IL-6), this does not independently lower mortality. Neurological prognostication requires a delayed, multimodal approach integrating clinical assessments and biomarkers like neuron-specific enolase (NSE), while accounting for confounders.
Conclusions. Post-CA management has shifted toward individualized, precision-based care, with strict normothermia and active fever prevention as the recommended standard. Accurate neuroprognostication necessitates adherence to guideline-directed timing and multimodal strategies. Future research should identify specific subgroups benefiting from hypothermia and develop adjunctive therapies.
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Copyright (c) 2026 Piotr Kowalewski, Eliza Kuchta, Natalia Kowalczyk, Kacper Wrzosek, Karolina Dudek, Jan Błażukiewicz, Klaudia Ciupak, Klaudiusz Garbacki, Lena Popek, Bartosz Dudek, Halina Piecewicz-Szczęsna
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