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Benton R Hunter,1 Timothy J Ellender1,2 1Department of Emergency Medicine, 2Department of Critical Care Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA Abstract: Landmark trials in 2002 showed that therapeutic hypothermia (TH) after out-of-hospital cardiac arrest due to ventricular tachycardia or ventricular fibrillation resulted in improved likelihood of good neurologic recovery compared to standard care without TH. Since that time, TH has been frequently instituted in a wide range of cardiac arrest patients regardless of initial heart rhythm. Recent evidence has evaluated how, when, and to what degree TH should be instituted in cardiac arrest victims. We outline early evidence, as well as recent trials, regarding the use of TH or targeted temperature management in these patients. We also provide evidence-based suggestions for the institution of targeted temperature management/TH in a variety of emergency medicine settings. Keywords: therapeutic hypothermia, cardiac arrest, heart arrest

Background: Acute heart failure (AHF) is a common presentation in the Emergency Department (ED), and most patients are admitted to the hospital. Identification of patients with AHF who have a low risk of adverse events and are suitable for discharge from the ED is difficult, and an objective tool would be useful., Methods: The highly sensitive Troponin T Rules Out Acute Cardiac Insufficiency Trial (TACIT) will enroll ED patients being treated for AHF. Patients will undergo standard ED evaluation and treatment. High-sensitivity troponin T (hsTnT) will be drawn at the time of enrollment and 3 hours after the initial draw. The initial hsTnT draw will be no more than 3 hours after initiation of therapy for AHF (vasodilator, loop diuretic, noninvasive ventilation). Treating clinicians will be blinded to hsTnT results. We will assess whether hsTnT, as a single measurement or in series, can accurately predict patients at low risk of short-term adverse events., Conclusion: TACIT will explore the value of hsTnT measurements in isolation, or in combination with other markers of disease severity, for the identification of ED patients with AHF who are at low risk of short-term adverse events., Competing Interests: Disclosure Mette Cole receives research support from Novartis and Roche Diagnostics. Karen Miller receives research support from NIH, PCORI, Novartis, Roche, and Trinity Biotech. Peter S Pang is or has been in the last 1 year a consultant for BMS, Janssen, Medtronic, Novartis, Trevena, scPharmaceuticals, Roche Diagnostics, and Relypsa. Sean P Collins is a consultant for Trevena, Cardiorentis, Novartis, Siemens, and Cardioxyl. Phillip Levy is a consultant for Janssen, Medtronic, The Medicines Company, Novartis, Trevena, Cardiorentis, Siemens, Roche Diagnostics, ZS Pharma, and Apex Innovations. Gregory J Fermann is a consultant for Pfizer and Janssen. The other authors report no conflicts of interest in this work.