OHCA patients with ROSC and GCS<8
In-hospital cardiac arrest patients not regaining consciousness
Patients with elevated intracranial pressure needing TTM
Acute MI & emergency-care patients
China Medical University Hospital, led by Head Nurse Yi-Chun Chou, developed the "Cool Down! Targeted Temperature Management" (TTM) care model. With ~2,000 out-of-hospital cardiac arrest cases annually in Taichung (highest among Taiwan's 6 metropolises), and as Central Taiwan's largest ER medical center and Level-Heavy emergency responsibility hospital, in 2013 the team launched the OHCA Registry (THUNDER) and in 2021 established the Central Taiwan AI Heart Network (real-time AI ECG interpretation via simplified patch). TTM follows the "rapid drop, gradual rise" principle: core temperature reduced to 32-36°C for ≥24 hours, then warmed at 0.15-0.5°C/hr, actively preventing fever. Team includes Nursing, Cardio/Cardiac surgery, Pulmonology, Neurology, Pharmacy, Nutrition, Respiratory Therapy, Rehab, Hospice, Social Work, and Discharge Planning. Six features/innovations: (1) bedside EEG monitoring for shivering/seizure; (2) Skin Care Bundle for skin injury prevention; (3) TTM standardized care + smart management; (4) integrated intra/extra-body TTM; (5) cross-team collaboration; (6) comprehensive critical care support.
Bedside EEG monitoring for shivering/seizure
Skin Care Bundle for skin injury prevention
"Rapid drop, gradual rise" standardized care
Smart management for real-time monitoring
Integrated intra/extra-body TTM equipment
Comprehensive critical care support
Average 2,000 OHCA cases/yr in Taichung
#1 in emergency volume among 6 metros
Largest ER medical center in Central Taiwan
2013 launched THUNDER OHCA Registry
2021 established AI Heart Network
Continuous EMT-paramedic training
Induction phase: rapid temp achievement in 2-4 hr
Maintenance phase: precise control, minimal fluctuation
Rewarming phase: stable rewarming
Normothermia phase: fever avoidance
Skin integrity maintained
Real-time smart temperature statistics
Real-time EEG seizure/shivering detection
Active distal warming for shivering
Standardized SOPs
Skin Care Bundle prevents pressure injury
Full-period 24-hour EEG monitoring
"Bedside EEG monitoring nursing" SOP
Comprehensive skin protection for patients
Comprehensive family care
Discharge planning linked to LTC
Hospice co-care integration
Health promotion & social work cooperation
High training satisfaction
AI ECG patch real-time interpretation
Central Taiwan AI Heart Network
THUNDER OHCA Registry
Benchmarked against Japan/Korea TTM care
Standardized nursing aligned with international
Smart management integrated into accreditation
Adopted Heping District rural caregiver training
First-aid training for indigenous mountain villages
Hosted Advanced EMT training
Improved pre-hospital emergency care quality
Provided government EMS platform reference
Cross-specialty, cross-team resource integration model
