2026 Southeastern Residency Conference

Sedation Practices in Patients Undergoing Targeted Temperature Management at 36° C
Grace Clark, Anais Solomon, Joanna Brennan, Bibidh Subedi
AdventHealth Orlando, FL

Background: Targeted temperature management (TTM) is the practice of cooling patients’ core body temperature for comatose patients after cardiac arrest to prevent brain damage. Historically, patients undergoing TTM to a goal of 33° C have been deeply sedated with Richmon Agitation and Sedation Scale (RASS) goals of -4 to -5 to avoid shivering, which increases the cerebral metabolic demand. In 2013, the TTM trial was published, prompting the 2015 ACLS guidelines to include 36° C for TTM. TTM to 36° C reduces shivering and possibly sedation needs. The objective of this study was to characterize sedation practices during TTM at 36° C, focusing on RASS goals and the sedation level achieved.


Methods: This was a multicenter, retrospective cohort study with 75 patients from AdventHealth Central Florida campuses who were enrolled between 4/1/2025 and 9/30/2025. Adult patients 18 years of age or older were included if they received TTM at 36° C after out-of-hospital or in-hospital cardiac arrest. Patients were excluded if they were pregnant, had multiple cardiac arrests, or if they were placed on extracorporeal membrane oxygenation (ECMO). The primary outcome was sedation level achieved measured by the RASS score for five days post cardiac arrest. Secondary outcomes included prescribed RASS goal, if the RASS goal was changed during TTM, sedation medications utilized, cumulative doses of sedative medications, Glascow Coma Scale (GCS) at baseline and on day five, time to extubation, incidence of seizure, incidence of tracheostomy, ICU and in-hospital mortality, and ICU and hospital length of stay.


Results: All 75 patients were included in analysis. The average age of our patients was 62 years old with 68% being male. Witnessed arrests occurred in 77.3% of patients with 25.3% having a shockable rhythm initially. The median time to ROSC in witnessed arrests was 12 minutes. Around 61.3% of patients received vasoactive agents within 1 hour of hospital admission. The median RASS achieved was -2.5 on day 1 and 0 on days 2-5. The most common RASS goals were -1 to -2 (73.3%) and 0 to -1 (14.7%), with 29.3% of patients having their RASS goals changed during TTM. The most common continuous sedation medications were fentanyl (78.67%), propofol (76%), midazolam (58.67%), and dexmedetomidine (30.67%). The cumulative daily dose for dexmedetomidine increased over the first 72 hours, while fentanyl, midazolam, and propofol doses decreased. Patients were on sedative continuous infusions for a median of 36 hours with a TTM median duration of 72 hours. The number of patients on continuous sedation was 67 (89.3%), 48 (64%), 38 (50.7%), 25 (33.3%), and 16 (21.3%) respectively for days 1-5. The number of patients on as needed sedation was 8 (10.7%), 11 (14.7%), 11 (14.7%), 8 (10.7%), and 7 (9.3%) respectively for days 1-5. Around 37% of patients had TTM discontinued early with 5.3% of them due to the patient following commands. Median GCS was 15 at baseline and 10 on day 5. Seizures occurred in 19 people (25.3%) for a median of 2.63 days. Shivering occurred in 11 people (14.7%) and 8 people (10.7%) received tracheostomy. The median time to extubation was 2.7 days. The median lengths of stay were 4 days for the ICU and 7 days for the whole hospitalization. Mortality occurred in 46 cases (61.3%) with all the patients dying during their ICU stay.


Conclusions: Our study found that most patients undergoing TTM at 36° C had lower sedation targets prescribed and achieved than have been historically attained. Most patients were able to complete the full 72 hours of TTM. Further prospective studies are warranted to evaluate optimal sedation target in this demographic.

Presentation Objective: Analyze current targeted temperature management (TTM) sedation practices within AdventHealth Central Florida division.