Transcript Video Barbara McLean - Protocol Selection May 19th Conexiant Video 2025 Hi, I'm Barbara McLean, and I'm here to talk to you about my journey with therapeutic hypothermia, AKA in today's current terms, targeted temperature management. In 2011 I was recruited to come to Grady Hospital by an incredible person, Dr. Kay Kennedy, who was the director of critical care, and my very first assignment working within the division of critical care was to evolve therapeutic hypothermia. At that time in the emergency department, there was a very excited fellow who was applying cooling therapies to patients postc cardiac arrest, and I got. Linked up to him and we together started to build an incredible program. Our program began in 2011 with targeted temperature to 33 degrees, and we loved our 33 degree journey. We used 33 degrees for many, many years, even when the evidence started to change because we felt that the strength of evidence for 33 degrees gave excellent neuroprotection. The problem though with 33 degrees is that it's a profoundly nurse intensive method, and the benefits of 33 degrees did not equal or equate to the risks of 33 degrees nor to the nurse intensivity at that time you could only if you had a cardiac arrest in the hospital or out of hospital at my hospital, you could only receive therapeutic hypothermia in. Cardiovascular intensive care unit, which meant that the burden for that was in a very small unit with an incredible dedicated staff, but what it also meant is all of the cardiac arrests we see now about 5 to 8 cardiac arrests a day. Now all of those don't survive to actually receive a targeted temperature that's designed to give them neural protection, but the ones that did always had to come to CVICU. We recognized that we were missing a lot of patients because of throughput issues, so after the uh the TTM2 trial we determined that we would change our temperature to 37 degrees. It made it simpler, easier to apply, opened the ability up to all the intensive care units at my hospital, Grady Hospital. And we really felt that that was going to be a significant and profound benefit for patients, so we just recently reviewed our CARS data from uh from uh 2024 and the CARS registry actually targets cardiac arrests and looks at outcomes and quite happily I would report to you that almost 35% of our cardiac arrest patients who receive. TTM actually survived to hospital survival. We don't have all of their neurologic outcome data, but I want to say I've had an incredible team of colleagues of nurses and APPs and physicians who've been on this journey in and out with me this whole time and some who've been on it with me since 2011 since our very first patient. Uh, that we have really evolved our practice and we're continuing to evolve our practice every day. We're always open to the new evidence, but I felt, I felt as the chairperson for the therapeutic hypothermia committee, AKA TTM that until the evidence was really strong, I didn't want to change the methodologies that we were using. So one of the really important aspects here is you might say, well, 2011 you started therapeutic hypothermia and you stayed. With 33 degrees and really only changed to 37 degrees two years ago and the reason that we did this was we felt that the evidence at the time wasn't strong enough for us to make a change and something that was already so embedded in our culture we were doing such fantastic work and recruiting patients and applying uh therapeutic hypothermia, but now we've transitioned to 37 degrees and we call it TTM. But let me tell you there are some challenges associated with. As well, when we were doing therapeutic hypothermia, 33 degrees, obviously there's a very unstable time as the patient descends to 33 and as they rewarm and there's a lot of electrical and chemical and metabolic instability that you have to be very aware of with 37 degrees we don't really have that, but we still have challenges because in the eyes of the majority of bedside nurses and providers in hospital, 37 degrees is normalthermia. This is not normal thermia, my friends. Please make an effort to call it what it is targeted temperature management. In my practice, we apply these cooling gel pads to our patient, and the water temperature does the rest because our patients stay within 0.5 degrees of 37 because the water temperature goes up and down in order to keep the patient there. But this is not just cooling a patient who has hypothermia. It is not just warming a patient who is hypothermic. It is controlling that temperature to control the metabolic demand and the other equivalents that may occur in the cerebral vault to provide neuroprotection. So in today's practice my challenge is making sure everyone calls this what it is targeted temperature management 37 degrees 72 hours. Don't take the pads off, don't think you've done your job and monitor water temperature because when that temperature is cold, patients making heat because when that temperature is. Warm patients losing heat, so I basically say the four S's when the patients and when the water temperature is cold, think sepsis, think seizure, think shiver, and when the water temperature is high, think shock the four S's and water temperature in this practice gives us such incredible information. I've been really thrilled to be in charge of. Therapeutic hypothermia to TTM since 2011 and I'm very fortunate to be able to reveal that we are really starting to see significant yield to our practice in terms of recovery for our patients postc cardiac arrest. Thank you. Created by
