CanadiEM MVP Infographic Series – Targeted Temperature Management at 33°C vs 36°C

In Infographics by Sparsh Shah1 Comment

In this issue of the MVP Infographic Series, we feature: “A randomized trial of protocol-based care for early septic shock” published by the ProCESS Investigators.1

This paper from the MVP series focuses on targeted temperature management post cardiac arrest. It was published by Neilson et al in The New England Journal of Medicine in 20131. At the time, therapeutic hypothermia was a controversial topic. Although international resuscitation guidelines recommended therapeutic hypothermia post cardiac arrest, only two trials showed benefit of therapeutic hypothermia2,3, and in one of the two trials, it was unclear whether the benefit was due to hypothermia or prevention of fever2. Therefore, this study aimed to compare targeted therapeutic hypothermia against targeted normothermia, with both regiments aiming to prevent fever, in a large multicenter RCT, to better elucidate the benefit of therapeutic hypothermia.

The authors divided cardiac arrest patients into two arms, one group receiving temperature targets to 33°C and the control arm targeted to 36°C. With data from 939 patients across 36 ICUs, their results showed no significant difference between the two arms. Interestingly, therapeutic hypothermia was not superior in neurological and mortality outcomes.


  1. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med. 2013; 369: 2197–2206
  2. The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002;346:549-556[Erratum, N Engl J Med 2002;346:1756.]
  3. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002;346:557-563

Sparsh Shah

Sparsh Shah is an incoming Emergency Medicine Resident at the University of Toronto. He has interests in trauma, global health, and healthcare innovation.
Alvin is currently a PGY5 in the FRCP EM program at McMaster University. He serves as Director of Design for CanadiEM and has interests in knowledge translation and health innovation.