cooling down after CPR

Trauma Columnist · Sep 12, 2004

I'm sorry but I don't understand what you are asking? Cooling down patient's temperature? Why? Maybe something else?

zambezi, BSN, RN · Sep 13, 2004

If the patient have lived through the CPR/Code situation, no we don't cool them down after cpr...(if that is what you mean)

If they didn't make it through the situation, it is safe to say that they cool down on their own...(insensitive, i know, but i couldn't help it :) )

Dirk · Sep 13, 2004

ok ..I try to explain :

Cooling down a patient after a cardiac arrest will let more pat. stay alive, and they will have a better outcome.

( pat. treated with hypothermie after cardiac arrest - 49% survived, with normothermie only 26% survived ( HACA-study))

You can use methods like cooling-lines, cooling-tents or a head-cooling-cap.

Sorry - my english is not as good to explain everything, but you can read it here :

http://www.erchacar.org/physician/physician_frame.html

Dirk

jax · Sep 13, 2004

I have just learned something new.

thankyou Dirk

Trauma Columnist · Sep 13, 2004

No problem - I wondered if hypothernia was what you were talking about. Your English is fine - I just didn't understand the question. I couldn't get the link to come up. I work in the emergency department and we don't use hypothermia after a code. I do know that for some people at high risk during major cardio-thoracic surgery - that in surgery they use hypothermia to slow down the metabolism. Welcome to ALl Nurses.

Dirk · Sep 13, 2004

thank you for the nice welcome!

i never used a cool line for intravasal cooling, but i think that this is a good way for the patient.

i have copied further information :

what is hypothermia:
cooling the body down to 32-34ºc.
why:
to reduce the damage to the brain and to the heart.
our studies show that cooling a victim of cardiac arrest, during and after resuscitation, improves the victim's chances of both survival and a normal life after the cardiac arrest.
making the heart and brain cool slows down how much energy they need and gives the doctors longer to get everything working better. also, it reduces the swelling and the scaring that occurs. we cool patients just like athletes who have hurt their limbs put them in ice baths.
when we cool people who have just had a cardiac arrest more of them leave hospital alive and more of them return to a normal life.
when:
as soon as the patient comes to the hospital. in some cases, cooling with ice packs may start in the ambulance.
how:
we put a tube (a catheter) into the big blood vessel in the leg (femoral vein) that takes blood back to the heart. on this tube there are long thin balloons. inside the balloons we circulate cold water from a cooling unit that is next to the bed . the water never mixes with the blood. the blood flows over the outside of the balloons.and gets cold. the blood flows to the heart and cools the heart. the blood then flows to the head and rest of the body and cools them.
for how long:
we cool the patient for 24 hour and then warm them back up to normal.
does it hurt:
no. most people do not even remember the tube being placed. some people shiver because of the cooling. however this usually settles quickly. we can give patients drugs to make the shivering stop if it does become a problem. patients tell us that they know that they are cold but they are not worried about it.

i don´t know, if you have seen the ilcor guidelines - if not, take a look :
http://www.erchacar.org/materials/guidelines/ilcor_guidelines.pdf
greetings
dirk

chris_at_lucas_RN, RN · Sep 13, 2004

This is fascinating--and certainly makes a lot of sense. Survival rates of 49% as opposed to 26% (assuming most other factors are controlled for) is impressive.

However, although I could get the site to come up for me, one must be a member to read the information, and membership is restricted to hospitals and physicians licensed in Europe.

Dirk, I hope you keep posting this information. I'm looking forward to reading more!

Danke.

AmiK25 · Sep 17, 2004

Our hospital has recently implemented a hypothermia protocol for patients that are s/p CP arrest from an MI. However, I do not believe we have used the protocol on our unit as of yet. Also, I know our neuro unit is trialing the intravascular cooling device right now but we have not seen it yet in our unit (Med/Surg/Trauma ICU). Sorry I don't have any first hand experience yet but just wanted to let you know that other hospitals are working on these protocols.

charles-thor · Sep 17, 2004

1. Since shivering can increase oxygen consumption upwards of 300%, wouldn't shivering during resuscitative measures always be a problem?

2. What about the profound left shift of the oxyhemoglobin dissociation curve starving tissues of badly needed O2?

3. Is there concern over further myocardial irritability in the face of already impaired conduction at such cold temperatures?

I understand hypothermia is induced during cardiopulmonary bypass, however other adjuncts (volatile anesthetics, benzos, ect.), in addition to cold, help preserve cerebral function. Results such as those previously described mean nothing outside of the context in which they were found. Can someone provide a link to the study?

Dirk · Sep 17, 2004

http://content.nejm.org/cgi/content/abstract/346/8/549?hits=20&where=fulltext&andorexactfulltext=and&searchterm=hypothermia&sortspec=Score%2Bdesc%2BPUBDATE_SORTDATE%2Bdesc&excludeflag=TWEEK_element&searchid=1095459518145_11309&FIRSTINDEX=0&journalcode=nejm

If you have the possibility to take a look in the New England Journal of Medicine, you will find the complete text. Just look for the paper with date : February, 21 2002.

Greetings

Dirk