Hello Fellow RNer's,
I was wondering if anyone has research journals on 'when to call Organ donation center when induced hypothermia has began' (after cardiac arrest).... We are trying to implement it in our "Hypothermia Protocol" and I would love some EBP to support it.
Thank you in advance
Oct 26, '12
AACN has a journal on hypothermia after cardiac arrest.
Oct 30, '12
If you are initiating a hypothermia protocol, the physician probably has determined the patient has a good chance of surviving and is just reducing the potential brain injury. Hypothermia does not necessarily save the life but improves the quality of life if saved. Some patients are too unstable post ROSC to have hypothermia initiated immediately if at all or may have very poor prognosis with extensive damage to heart and other organs from the cardiac arrest. Hypothermia protocol is an expensive endeavor if there is brain death and any chances of survival are nil. If the protocol is initiated with a poor prognosis of any recovery, brain function will have to be analyzed once the 24 hour period has past and rewarming is complete with all the brain altering meds discontinued. If there is still brain function, your state would have to recognize the non brain death donor program for procurement of major organs in the OR. If not, the usual protocols would need to be followed after life support is discontinued with the donation of other body parts which are not life support dependent.
A good place to start is with your state's organ procurement team for their policies and the AHA guidelines for which patients should have hypothermia initiated on.
Dec 2, '12
This is a very grey area. I included the webpage from LifeSource on referral triggers. The catch is that if you are using neuromuscular blockade as part of your protocol, many of these tests for brain death will not be usable. I know there are also case reports of prolonged duration of action of sedatives, analgesics, and NMBs falsely leading to a conclusion of brain death and thus interventions and support may have been withdrawn prematurely. One of our neurology fellows was performing research on this just recently in our ICU. Additionally, I would be cautious about drawing any conclusions about brain death (or other triggers for referral) until the rewarming phase is complete. The question would then be, as just mentioned, have all the sedatives, analgesics, and NMBs been eliminated? Is the post-rewarming neurologic evaluation accurate? If you would like, I could ask the neurology fellow for some literature resources on this. Let me know.
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