Cooling/Induced Hypothermia S/P Arrest

[Penelope_Pitstop, BSN, RN]

My hospital's ICUs do a lot of induced hypothermia after cardiac arrest. I don't work in the ICU, and I've been involved in several codes but my duties end once the patient is transported to the ICU.

I have a few questions, if y'all don't mind, about this process.

First of all, who is "a candidate" for this? I've heard the intensivist describe a resus patient as "not a candidate" before, but I don't know why.

Secondly, and this may sound stupid, but how is it done? I know each hospital is different. I've read our protocol but it doesn't describe exactly what is done, just the orders the intensivists are to write.

And, finally, has anyone actually seen a good outcome with this? Maybe it's because all of my patients were fairly ill, but all of the code patients I know of who were cooled never left the hospital alive...actually, I'm not sure if any reached the point of extubation.

Thanks, everyone, for any and all input. Because this is something that wasn't in vogue during nursing school, I never learned about it, and I haven't done any time in the ICU, so I haven't seen it firsthand!

[aCRNAhopeful]

Candidates need to be comatose s/p arrest and hemodynamically stable with or without pressors. There is also a timeframe as to when to start.. like within 4 hours or something. To actually cool them you can use iced saline IV, lavages, etc to start and then use a device like the Arctic Sun which is large pads on the skin that have cold water circulate through them and is connected to a thermometer probe to regulate body temp at a target. In my limited experience it seems like we do have about 1/4 come back successfully without major neuro deficits.

[TulsaTime]

It is correct the patient needs to be comatose and hemodynamically stable with or without pressors. There are a number of other factors (overdose, coagulopathy) that may make a patient unsuitable for the protocol.

It should be initiated within 6 hours of return of spontaneous circulation although we occassionally stretch this out a bit on the premise that it won't do any harm. The cooling is often started prehospital by EMS if they are bringing in a postcode patient with chilled saline. We will start chilled saline or use gastric lavage (did lavage for the first time this weekend & it worked great!) and ice packs. We use the gaymar with the hypothermia wraps--2 full leg wraps & 1 chest wrap. These go completely around the patient & circulate chilled water continuously (basically a cooling blanket turned into a wrap).

The patient is chilled to 32-34 C for 24 hours & then slowly rewarmed over 24 hours. They are kept sedated this entire time.

It is important that you understand the purpose is to help preserve neurologic function IF the patient survives. Most post arrest patients do not survive to discharge, but the research shows if they do they have better neurological outcomes with the hypothermia protocol.

In our hospital my team (Rapid Response) initiates and resources for all of the ICU's on this so I'm pretty well versed in it. We did 4 in the last week. Let me know if you have any other questions!