CPR

Editorial Team / Moderator · Feb 26, 2017

Targeted therapeutic hypothermia has been demonstrated to help preserve neurological functional in patients after a cardiac arrest. Do you have a unit educator? These are perfect questions to review with them! :)

https://www.americannursetoday.com/therapeutic-hypothermia-after-cardiac-arrest-what-why-who-and-how/

firemedic12, BSN, RN, EMT-P · Feb 26, 2017

I was always told it was heavily dependent on the patient's neurological status once ROSC is achieved. Some get placed on arctic sun protocol post arrest. I've yet to see someone get placed on AS and live once we started to warm them.

WestCoastSunRN, MSN, CNS · Feb 27, 2017

I was always told it was heavily dependent on the patient's neurological status once ROSC is achieved. Some get placed on arctic sun protocol post arrest. I've yet to see someone get placed on AS and live once we started to warm them.

I have.

I think the cooling is done in some units on all post arrest patients unless they become comfort care. in my burn ICU we don't routinely cool post code

twss2323 · Feb 27, 2017

There are certain requirements to cool, to include ROSC within an hour and a GCS score. I can remember the exact score but it's a GCS less than 8 or 12 I believe. If the patient is responsive and following commands, no need to cool them.

BSN16 · Feb 28, 2017

There are certain requirements to cool, to include ROSC within an hour and a GCS score. I can remember the exact score but it's a GCS less than 8 or 12 I believe. If the patient is responsive and following commands, no need to cool them.

I once asked a doc this question and he told me it also depends on what type of rhythm they were in. He told me only shockable rhythms were hypothermia-ed (?).

ASM24RN · Mar 2, 2017

At our facility, we use the Thermogard hypothermia protocol which is a femoral or internal jugular catheter that has balloons that are filled with propylene glycol solution. The solution is in a console that you can control the target temp and how fast you want to cool or rewarm. Indications for hypothermia protocol are mainly a witnessed arrest and being unconscious. You wouldn't initiate this for a patient that was asystole, only shockable rhythms like mentioned above also. I've been an icu nurse at this facility for 3 years and I've seen wonderful outcomes with the thermogard vs basically ice packs/cooling blanket. It's super interesting, too!

jj224 · Mar 4, 2017

I don't know which patients are to be cooked.

Our therapeutic hypothermia protocol was for patients with a witnessed cardiac arrest, shockable rhythm, and rosc within a certain amt of time. I've seen people walk out of the hospital after this, and I've seen people leave in a heorifice. I'd say 70/30 dead / alive

MYSTICOOKIEBEAR · Mar 6, 2017

Hopefully no patients get cooked? :linkme: :no: :roflmao:

The reason that we start the Arctic Sun protocol aka therapeutic hypothermia is if we are worried about Anoxic Brain Injury. By cooling the patient, decreasing their metabolism, decreasing their O2 needs, we optomize O2 delivery to the brain and hopefully optomize their recovery.

There are times when a patient codes, where after a round or two we achieve ROSC, and they are completely neurologically intact. Im talking about not needing restraints, writing stuff down, watching TV whilst still intubated (Not gonna lie that kinda weirds me out when they continue on their day like nothing happened :eek: ). These people are not appropriate candidates for Arctic Sun since their is no evidence of anoxic brain injury.

But there are other times when a patient codes and they are completely unresponsive, no sedation, not moving, sluggish pupils, barely to no reflexes. That is when the Arctic Sun protocol is appropriate but it is usually Neurology who decides what is appropriate.