{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T19:14:55Z","timestamp":1783624495896,"version":"3.55.0"},"reference-count":14,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Hypothermia and Temperature Management"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:p>The critical care unit at the University Hospital of Wales is a 38-bedded tertiary center. In 2023, the unit admitted 1251 unscheduled patients, of which 131 were out-of-hospital cardiac arrest (OOHCA) patients. The unit also participated in the Targeted Temperature Management 2 study and adopted the findings shortly after its publication in 2021. This gave us a unique exposure into the pitfalls associated with changing surface cooling protocols. The aim of this quality and safety initiative was to explore the causes of failure to comply with normothermic temperature targets in the OOHCA population, following a protocol change away from targeted therapeutic hypothermia. This article uses surface cooling data from OOHCA survivors. We discuss our findings from analysis of surface cooling data from 36 patients\u201413 pre-protocol change (targeted hypothermia) and 23 post-protocol change (targeted normothermia). Concerningly, following the change to targeted normothermia, rather than therapeutic hypothermia, the fever burden increased from an average of 2 to12 hours per patient. To address this problem, we reviewed the data and identified several causes of this failure. These failures included the failure to start the therapy at the selected trigger point, the interruption of therapy, inadequate pad sizing, and the failure to select the correct protocol. Surface cooling pitfalls are not commonly discussed in the literature, and therefore there remains a risk that units may overlook them, either when transitioning between protocols or when continuing with an ongoing surface cooling device. With evidence suggesting that pyrexia contributes to poorer outcomes, it is of vital importance that staff are aware of any potential pitfalls of surface cooling devices to mitigate unnecessary fever burden.<\/jats:p>","DOI":"10.1177\/21537658251378205","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T08:34:31Z","timestamp":1757579671000},"page":"123-129","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Stepping Out of the Cold: The Use of Surface Cooling Devices for Targeted Normothermia Temperature Management in Out of Hospital Cardiac Arrest Survivors\u2014Common Pitfalls and Proposed Solutions"],"prefix":"10.1177","volume":"16","author":[{"given":"Emma","family":"Ford","sequence":"first","affiliation":[{"name":"University Hospital of Wales, Cardiff, Wales, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josh","family":"Fox","sequence":"additional","affiliation":[{"name":"University Hospital of Wales, Cardiff, Wales, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Williams","sequence":"additional","affiliation":[{"name":"University Hospital of Wales, Cardiff, Wales, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"e_1_3_1_2_1","unstructured":"Adult Critical Care Directorate. Normothermic Targeted Temperature Management Log (Post Cardiac Arrest) v1 Aug 2021. Clinbee; 2022. Available from: https:\/\/app.clinibee.com\/articles\/1192ad21-d000-4f15-b87f-0a34707fb18b?fbclid=IwZXh0bgNhZW0CMTAAAR26eFTr5dhR8qGqA07g5e2vuAcCo0m-8NaN7ShlvjI66trcjYzEuIGUJ1M_aem_AZ4POsdC8ZzpwYygw8kxvTvQXWOQzab6MLwHtku50p4pr-GDail_2oof4Rcfxg37SzhfZNRPvwAEXlat34Q1nSbS [Last accessed: 14May]."},{"key":"e_1_3_1_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004128.pub3"},{"key":"e_1_3_1_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-025-07883-4"},{"key":"e_1_3_1_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2100591"},{"key":"e_1_3_1_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa012689"},{"key":"e_1_3_1_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12010259"},{"key":"e_1_3_1_8_1","unstructured":"NICE. Arctic Sun 5000 for therapeutic hypothermia after cardiac arrest. 2017. Available from: https:\/\/www.nice.org.uk\/advice\/mib112\/chapter\/The-technology [Last accessed: 14May]."},{"key":"e_1_3_1_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1310519"},{"key":"e_1_3_1_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2022.01.009"},{"key":"e_1_3_1_11_1","unstructured":"OHCAO Registry. Out-of-Hospital Cardiac Arrest Overview: English Ambulance Services 2022*. 2022. Available from: https:\/\/warwick.ac.uk\/fac\/sci\/med\/research\/ctu\/trials\/ohcao\/publications\/epidemiologyreports\/ohcao_epidemiological_report_2022_england_overview_final_07.12.2023.pdf [Last accessed: 30April 24]."},{"key":"e_1_3_1_12_1","volume-title":"Sedation, Temperature and Pressure After Cardiac Arrest and Resuscitation","author":"Region Skane","year":"2024","unstructured":"Region Skane. Sedation, Temperature and Pressure After Cardiac Arrest and Resuscitation. In: (Lund University LS, Copenhagen Trial Unit CfCIR, The George Institute for Global Health A, et al. eds.) 2024."},{"key":"e_1_3_1_13_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-5229.164806"},{"key":"e_1_3_1_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-022-06620-5"},{"key":"e_1_3_1_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.161.16.2007"}],"container-title":["Therapeutic Hypothermia and Temperature Management"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21537658251378205","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21537658251378205","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21537658251378205","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T19:00:29Z","timestamp":1783623629000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21537658251378205"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,11]]},"references-count":14,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9,1]]}},"alternative-id":["10.1177\/21537658251378205"],"URL":"https:\/\/doi.org\/10.1177\/21537658251378205","relation":{},"ISSN":["2153-7658","2153-7933"],"issn-type":[{"value":"2153-7658","type":"print"},{"value":"2153-7933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,11]]}}}