Targeted Temperature Management in Postresuscitation Care: From Evidence to Clinical Practice

Neurological injury remains a major determinant of survival and functional recovery in patients following cardiac arrest.Targeted temperature management (TTM) has emerged as a cornerstone in mitigating secondary brain injury by maintaining a stable core temperature within the range of 32-37.5°Cfor a minimum duration of 24 hours, followed by strict fever prevention for 72 hours.While early trials emphasized therapeutic hypothermia (32-34°C), recent high-quality evidence suggests that temperature control within a broader range, combined with fever prevention, may be equally effective.This narrative review explores the pathophysiological basis, landmark clinical trials, and evolving guidelines on TTM, with a focus on the 2023 American Heart Association (AHA) and European Society of Intensive Care Medicine (ESICM) recommendations.We discuss the latest insights from the TTM2 trial, which challenged the superiority of deep hypothermia over normothermia while reinforcing the need for active fever control (< 37.7°C).Additionally, we outline practical considerations, including patient selection, cooling methods, shivering management, sedation strategies, electrolyte monitoring, rewarming protocols, and complications associated with TTM.A protocol-driven approach is essential to ensuring the successful application of TTM in diverse clinical environments.