Re-arrest during Hypothermia induction

Specialties CCU

Published

Question:

A patient goes into V-Fib/ Asystole or pulseless Vtach during the induction phase. Do you rewarm the patient immediately? Do you wait until you are thinking about ending resuscitation efforts--"pt is not dead until they are warm and dead"--or do you just not rewarm them? I understand that the vasodilation diring rewarming will not help the patient in this situation, but I am still not sure what the correct thing to do it. I was reading an article about induction and it stated that rewarmjng is done for any persistent life threatening dysrhythmias, but the nurses in the ICU I work in acted like it was obvious that we should not rewarm them. Thanks for input!

MunoRN, RN

8,058 Posts

Specializes in Critical Care.

It should be less of any issue now that the recommendations for the cooling target have changed to keeping the patient closer to 36 degrees C, so really we're maintaining normothermia more than cooling.

Arrhythmias were an adverse effect of the old cooling target range (32-34 degrees), in which case the benefits of cooling were balanced against any harm it was causing (arrhythmias, coagulopathies, organ hypoperfusion, etc). If a patient had arrhythmias that were difficult to treat then generally the importance of a perfusing rhythm was prioritized over the neuroprotection of cooling, although if the arrhythmia was due to a treatable contributing cause then the underlying cause would be treated (ie low K/mag) and cooling would continue.

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