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
  • 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: 
Course expires: 

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
Please login or register for a Baptist Health CME account to take this course.

Required Hardware/Software

PC/Mac Users
PC/Mac Users

This site is supported on the most recent stable releases of the following browsers:

Click Here to Download Google Chrome
Google Chrome
Microsoft Edge
Microsoft Edge
Moxilla Firefox
Mozilla Firefox
Internet Explorer

Attention: Internet Explorer Users
This site offers limited support for Internet Explorer 11 (IE11). When using IE11, you will be prompted to download course videos instead of viewing them in the browser. After the course video downloads, the recordings will play.

Mobile Users
Mobile Users

This site is supported on the following mobile devices:

  • Apple iOS mobile devices running iOS 10 or later
  • Android mobile devices running Android 4.4 or later, with the latest release of Google Chrome or Mozilla Firefox
Technical Support
Technical Support

If you are experiencing technical difficulties or have received an error message, please send an email to and include a print screen of the error message, your browser name and version, username and URL where the error occurred. You can expect a response within 48 hours.