Hey Group,

Have you guys had any experience working with post cardiac arrest hypothermia as an intervention, either in the ER or ICU. I have been reading about it because we plan on implementing it at my hospital. Any input.

Joe

I work in a Level 1 ICU that incorporates MICU/SICU, CCU, Neuro ICU and Trauma. We have used hypothermia for post MI and Neuro pts. It works and works well when intitated in a timely and apporpriate manner.

We've done some post-arrest hypothermia at my facility, but I believe only certain units can perform it (Med ICU, Surg ICU, and Cardio ICU, IIRC), requiring transfers from any other units.

Mike in Michigan

We don't do it here at my hospital but after reading up on the Trauma Death Triangle (hypoxia, hypothermia and acidosis) I realize how careful physicians must be when initiating this type of therapy.

In the City of New York, FDNY (Fire Department of the City of New York) ambulances are mandated to bring post cardiac arrest patients only to ED's that can induce hypothermia. Here's some great articles on how they did it:

http://www.jems.com/resources/supple...rest_care.html
http://news.corporate.findlaw.com/pr...t20090952.html

We initiate our hypothermia protocol in the ED with ROSC pts...we've seen some very impressive results when it's started early. Very intensive care but once the pt is at target range everything flows pretty well. The AACN website has a new CE with some great info if you haven't checked it out yet.

On our ambulance the ROSC protocol has been modified to include rapid infusion of chilled saline in patients who have altered mental status, are normoglycemic, normotensive, and have no signs of CHF. Each ambulance carries coolers with 2 liters of NSS at around 0 C. Since we're a suburban service, that's enough to start cooling the patient while we get him to a hospital.

We use it and I've seen good results. The machine we use is called the Arctic Sun and it includes pads that stick around the torso and thighs. It automatically cools the patient to the desired temperature. Medication is given to combat shivering, since this increases O2 demand and the whole point of this therapy is to reduce O2 demand. The thing that makes me most nervous about it is that patients often become bradycardic with rates down into the high 30s. Although they remain stable, it's just frightening since this would be unacceptable in most any other patient population.

We worked with the local paramedic groups that transport patients to our hospital to ensure that they have coolers with chilled NS to initiate the hypothermia protocol in the field.