SAQ 183 – Resuscitation – targeted temperature management and vasopressin

Question 8. targeted temperature management and vasopressin.

a. Temperature aim

• 36 C.

b. Justification

• Use strict targeted temperature control and avoid hyperthermia.
• The 2013 TTM trial showed no mortality advantage from 33 C compared with 36 C.
• The trial showed no neurological-outcome advantage from 33 C compared with 36 C.
• Serious adverse effects were more frequent at 33 C.
• Temperature control may reduce metabolic demand and ischaemia-reperfusion injury and supports coordinated post-arrest care.

c. Out-of-hospital role

• Vasopressin is not included in standard resuscitation guidelines.
• Vasopressin alone may improve hospital admission after asystolic arrest compared with adrenaline.
• A long-term survival benefit has not been established and evidence is insufficient for routine use.

d. In-hospital role

• Vasopressin is not part of standard ACLS treatment.
• Small trials have not shown a clear advantage over adrenaline alone.
• Vasopressin-steroid-adrenaline combination therapy may improve ROSC and favourable survival, but evidence remains limited.