Penn Medicine's TTM Academy Podcasts

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: Salcido DD et al, “Regional incidence and outcome of out-of-hospital cardiac arrest associated with overdose.” Resuscitation 2016; 99:13-19.http://dx.doi.org/10.1016/j.resuscitation.2015.11.010 Katz AZ et al, “Outcomes of patients resuscitated from cardiac arrest in the setting of drug overdose.” Resuscitation 2015; 94:23-27.http://dx.doi.org/10.1016/j.resuscitation.2015.06.015 Khan S et al, “Impact of Targeted Temperature Management on ED Patients with Drug Overdose–Related Cardiac Arrest.”, Journal of Medical Toxicology 2019; 15:22–29. https://doi.org/10.1007/s13181-018-0686-0

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 brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest."Acta Anaesthesiol Scand. 2018 May;62(5):635-647. doi: 10.1111/aas.13074. https://www.ncbi.nlm.nih.gov/pubmed/29363101

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 oxygen as tolerated to maintain adequate O2 saturation, but it’s not clear how well this is done- many patients are left on high oxygen “dose” for hours.   Key readings for this podcast: Robert BW et al, “Association Between Early Hyperoxia Exposure After Resuscitation From Cardiac Arrest and Neurological Disability: Prospective Multicenter Protocol-Directed Cohort Study.” Circulation. 2018 May 15;137(20):2114-2124. https://www.ncbi.nlm.nih.gov/pubmed/29437118 Kilgannon JH et al, “Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality.” JAMA. 2010 Jun 2;303(21):2165-71. https://www.ncbi.nlm.nih.gov/pubmed/20516417

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) – but evidence is now accumulating in support of the idea. Key readings: Nichol G et al, “Regional systems of care for out-of-hospital cardiac arrest: A policy statement from the American Heart Association.”, Circulation 2010;121:709-29. https://www.ncbi.nlm.nih.gov/pubmed/20075331 Elmer J et al, “Long-Term Outcomes of Out-of-Hospital Cardiac Arrest Care at Regionalized Centers.”, Ann Emerg Med 2019; 73:29-39. https://www.ncbi.nlm.nih.gov/pubmed/30060961

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.

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/    

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 for clinical decision making.

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 not be used for clinical decision making.