Ethical Challenges Related to Therapeutic Hypothermia and Discussions About Prognosis

Studies have shown that therapeutic hypothermia, also known as Targeted Temperature Management (TTM), has proven beneficial by improving outcomes in unconscious survivors of out-of-hospital cardiac arrest. While administering this therapy it is difficult for clinicians to provide clear prognostication to families; in fact, determination of neurological prognosis is unreliable before at least 72 hours post-rewarming. The clinician’s prognosis for survival, awakening from coma or future quality of life can strongly influence decisions regarding the continuation of life-sustaining treatments. This poses ethical challenges for clinicians.

Target Audience

Physicians, Physician Assistants, Nurse Practitioners, Respiratory Therapists, Medical Students and other interested healthcare professionals.

Learning Objectives

  • Explain how Targeted Temperature Management (TTM) can affect the ability to prognosticate patient outcomes.
  • Utilize an effective communication approach to explain prognosis uncertainty to legal decision makers.
  • Recognize the limitations that the TTM process brings regarding decisions to appropriate withdrawal of life-prolonging interventions.
Additional information
Bibliography: 
  • Perman, S. M., Kirkpatrick, J. N., Reitsma, A. M., Gaieski, D. F., Lau, B., Smith, T. M., ... & Becker, L. B. (2012). Timing of neuroprognostication in postcardiac arrest therapeutic hypothermia. Critical care medicine, 40(3), 719.
  • Grossestreuer, A. V., Leary, M., Abella, B. S., & Gaieski, D. F. (2011). Relation Between Time to Arousal and Neurologic Outcomes in Cardiac Arrest Patients Treated with Therapeutic Hypothermia.
  • Nielsen, N., Wetterslev, J., Cronberg, T., Erlinge, D., Gasche, Y., Hassager, C., ... & Pellis, T. (2013). Targeted temperature management at 33 C versus 36 C after cardiac arrest. New England Journal of Medicine, 369(23), 2197-2206.
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 General certificate of attendance
  • 1.00 Nurse Practitioners
  • 1.00 Florida Board of Respiratory Therapy
Course opens: 
05/01/2018
Course expires: 
04/30/2021

Eduardo Martinez-Dubouchet, M.D.
Associate Medical Director of eICU
Baptist Health South Florida
Miami, Florida

Eduardo Martinez-Dubouchet, M.D., indicated that neither he nor his spouse/partner has relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentation or discussion.

Non-faculty contributors and others involved in the planning, development and editing/review of the content have no relevant financial relationships to disclose.

Disclosure Policy and Disclaimer

Baptist Health South Florida is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Baptist Health has been re-surveyed by the ACCME and awarded Commendation for 6 years as a provider of CME for physicians.
             
Baptist Health South Florida designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 General certificate of attendance
  • 1.00 Nurse Practitioners
  • 1.00 Florida Board of Respiratory Therapy
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