A new multicenter trial published in NEJM, commonly known as the “TTM2” trial, evaluated treating patients resuscitated from out-of-hospital cardiac arrest with targeted temperature management to 33C versus controlled normothermia, and found that outcomes were equivalent. Does this mean the end of TTM as we know it? In this podcast, Dr. Benjamin Ab…

Electrocardiography (ECG) represents a central diagnostic tool in the post-arrest evaluation of patients resuscitated from out-of-hospital cardiac arrest (OHCA), and it should be acquired immediately after achievement of ROSC to identify the need for an urgent coronary angiography, which is indicated only in the case of ST-segment elevation myocard…

While we have focused on the science of targeted temperature management and other care strategies for critically ill survivors, it is important for us to remember that real people experience cardiac arrest and the consequences. In this unique episode, Dr. Benjamin Abella interviews Kristin Flanary, who jumped into action to provide 10 minutes of by…

The role of oxygenation during critical illness remains a major question. Is extra oxygen harmful or helpful? What oxygen levels should we target, both for respiratory failure and for patients after cardiac arrest? Dr. Benjamin Abella discusses these topics, and reviews a hot-of-the-press work from European investigators (the “HOT-ICU”) trial, publ…

Critical illness from COVID19 remains a major challenge to health systems worldwide. When patients progress to in-hospital cardiac arrest (IHCA), what is the chance of survival? Studies have so far revealing conflicting answers to this important question. What is the role of post-arrest care bundles, including TTM, in the care process? Dr. Felipe T…

Dr. Felipe Teran joins Drs. Cindy Hsu and Hans van Schuppen to discuss recent guidance regarding cardiac arrest resuscitation during the COVID-19 pandemic. Key publications referenced in this episode: Couper K, Taylor-Phillips S, Grove A, et al. COVID-19 in cardiac arrest and infection risk to rescuers: A systematic review. Resuscitation. 2020; 151…

Dr. Felipe Teran discusses the recent studies pertainig to OHCA during the COVID-19 pandemic. Key publications referenced in this episode: Baldi E et al. Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. N Engl J Med 2020 Apr 29; [e-pub]. (https://doi.org/10.1056/NEJMc2010418) Marijon E, Karam N, Jost D, et al. Out-of-hospital c…

Dr. Abella discusses a very recent American Heart Association scientific statement on cardiac arrest survivorship, increasingly recognized as an important topic around the globe. While many studies have evaluated survival to hospital discharge, or even survival at 90 or 180 days post-arrest – survival is not enough. Increasing data suggest that eve…

Drs. Teran and Abella discuss a hot-off-the-press survey study by Maciel CB et al (Critical Care Medicine, 2020), probing physician perspectives and practice on post-arrest neurologic assessment and prognostication. Do all of us follow the international guidelines for this phase of care? What are points of confusion in current “real world” practice…

Drs. Abella and Teran discuss the scientific literature surrounding gender differences in care during and following cardiac arrest. From differences in bystander CPR provision for public cardiac arrests to post-arrest DNR status and cardiac catheterization; listen to hear more. Key publications for this episode: Lindgren E et al. Gender differences…

Drs. Robert Neumar and Cindy Hsu (both at University of Michigan) continue their discussion with Dr. Felipe Teran following the plenary “Year in Review” presentation by Dr. Neumar at the American Heart Association Resuscitation Science Symposium (ReSS) in Philadelphia. If you missed ReSS, this is your chance to hear summaries of the top studies tha…

Resuscitation Science Top Studies of 2019: Part 1 of 2 Drs. Robert Neumar and Cindy Hsu (both at University of Michigan) are guest presenters in this special TTM Academy Podcast, hosted by Dr. Felipe Teran. They recap the plenary “Year in Review” presentation by Dr. Neumar at the American Heart Association Resuscitation Science Symposium (ReSS) in …

Drs. Teran and Abella discuss the role of transesophageal echocardiography (TEE) in the resuscitation of cardiac arrest patients. Listen for details of how this cutting-edge application of TEE could play a role in improving arrest diagnostics, CPR quality and possibly arrest outcomes. Key Reading: Teran F et al. “Evaluation of out-of-hospital cardi…

Earlier this week, results from the HYPERION trial were published in the New England Journal of Medicine. Drs. Abella and Teran discuss the use of TTM for patients resuscitated from cardiac arrest with a non-shockable initial rhythm. Suggested Readings: Lascarrou JB et at., “Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhyth…

Following the success of Episode 6, which discussed the scientific evidence for ECMO in cardiac arrest, we decided to take a deeper look at the implementation of ECMO in the ED. Drs. Felipe Teran and Joseph Tonna discuss the utilization of ECMO for refractory cardiac arrest, the expansion of hospital ECMO programs to the emergency department and im…

Drs. Teran and Abella discuss the role of TTM for patients following cardiac arrest caused by opioid overdose. Several recent observational studies are reviewed to understand the demographics of patients who suffer opioid-related cardiac arrest, their outcomes, and whether TTM may be beneficial during post-arrest for these patients. Key readings: S…

Following resuscitation from cardiac arrest, accurate evaluation of neurological recovery can help guide patient care and family decisions. In this podcast, Drs. Teran and Abella discuss a recent investigation into the use of MRI imaging in prognostication following resuscitation from arrest. Key reading for this podcast: Wallin E et al, "Acute bra…

Episode 8 – Oxygen Delivery After Cardiac Arrest Resuscitation During cardiac arrest resuscitation, most patients are intubated and placed on 100% oxygen. In this podcast, Drs. Teran and Abella discuss recent investigations that suggest that too much oxygen may worsen post-arrest injury. Global resuscitation guidelines suggest down-titration of oxy…

Drs. Felipe Teran and Ben Abella discuss an important recent publication in Annals of Emergency Medicine by Elmer et al, in which some of the strongest evidence to date are presented that support the concept of “cardiac arrest centers”, much like trauma or stroke centers. This has been proposed before (Nichol G et al, Circulation 2010 – see below) …

Drs. Benjamin Abella, John Greenwood and Felipe Teran discuss the use of ECMO (extra corporeal membrane oxygenation) for cardaic arrest patients. Referenced article: Weisfeldt ML, Becker LB. Resuscitation after cardiac arrest: a 3-phase time-sensitive model. JAMA. 2002 Dec 18;288(23):3035-8. https://doi.org/10.1001/jama.288.23.3035…

Dr. Felipe Teran discusses with Dr. Ramani Balu the importance of post-arrest neurological monitoring. The Online TTM Course is now OPEN! Visit upenn.cloud-cme.com/ttmonline for more information or to register.Penn Medicine TTM Academy

Dr. Abella discusses the recent publication in JAMA regarding the PRINCESS trial of intra-arrest brain cooling. JAMA Article: https://doi.org/10.1001/jama.2019.4149 Pre-hospital cold saline: https://doi.org/10.1001/jama.2013.282173 TTM Academy: https://pennmedonline.upenn.edu/ttmacademy/Penn Medicine TTM Academy

Dr. Abella discusses neuroprognostication following cardiac arrest and how long to continue care before considering withdrawl. TTM Academy: www.med.upenn.edu/resuscitation/ttm-academy.html For updates: text TTM to 31996 or email TTMtraining@pennmedicine.upenn.edu ** TTM Academy podcasts are intended for medical education only and should not be used…

Dr. Abella discusses the recent publication - Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. For the full article abstract visit: https://www.nejm.org/doi/full/10.1056/NEJMoa1816897 ** TTM Academy podcasts are intended for medical education only and should not be used for clinical decision making.…

Welcome to the first episode of Penn Medicine's TTM Academy Podcast. Dr. Benjamin Abella discusses the goal temperatures for TTM. Send ideas for new topics to TTMtraining@pennmedicine.upenn.edu Learn more about TTM Academy: www.med.upenn.edu/resuscitation/ttm-academy.html ** TTM Academy podcasts are intended for medical education only and should no…