Volume 30, Issue 172, June 2026

Targeted Temperature Management After Cardiac Arrest: From Therapeutic Hypothermia to Active Normothermia

Zuzanna Żurawska^1♦, Sandra Prolejko², Weronika Kotnis²

¹Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
²Medical University of Łódź, Kościuszki 4, 90-419 Łódź, Poland

^♦Corresponding author
Zuzanna Żurawska, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland

ABSTRACT

For a long time, targeted temperature management (TTM) has been considered a crucial neuroprotective intervention in post-cardiac arrest care. Once spontaneous circulation returns, a cerebral ischemia-reperfusion injury may occur. This significantly increases mortality while also contributing to deteriorating neurological outcomes in survivors. These factors have prompted research into therapeutic hypothermia as a means to reduce secondary brain injury. Mild hypothermia (32–34°C) improved both survival and neurological recovery in comatose survivors of out-of-hospital cardiac arrest, according to early randomized controlled trials published in 2002. Consequently, hypothermia protocols were widely adopted in international resuscitation guidelines. Nevertheless, the extent of this benefit has since been reassessed in later large-scale studies. No discernible difference in all-cause mortality or neurological outcomes between the groups in the 2013 trial, comparing temperature targets of 33°C and 36°C among patients, was observed. More recently, targeted hypothermia at 33°C did not lower six-month mortality when compared to targeted normothermia combined with active fever prevention, according to a 2021 study. The trials also indicated a potential increase in adverse events like arrhythmias, but didn’t find any consistent benefits in terms of survival or neurological outcomes compared to controlled normothermia. Overall, the growing body of research has pivoted its focus to clinical practice, straying away from routine induction of therapeutic hypothermia and moving towards active prevention of fever. However, there still remains uncertainty regarding optimal temperature targets and possible advantages amongst particular patient subgroups, thus highlighting the need for further research to improve postcardiac arrest temperature management techniques.

Keywords: targeted temperature management, post-cardiac arrest, therapeutic hypothermia, fever prevention, active normothermia

Medical Science, 2026, 30, e98ms3860

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Published: 12 June 2026