Hypothermia s/p cardiac arrest...waking up

Specialties MICU

Published

Specializes in CCRN, ED, Unit Manager.

So at a new facility I work at, we were reviewing hypothermia protocol. I asked "what if the patient wakes up and is following commands?" and everyone laughed and said "what?? they're on nimbex and sedation, they won't" and even went on to say that if they woke up during induction to increase sedation and nimbex and continue on. WHAT??

It made me question myself immediately, but at my old facility, I know I've had patients that coded, got hypothermia protocol ordered, and during the process of initiating the induction phase (nimbex, cooling, propofol, etc.) they've woken up and were able to follow commands (squeeze hands). Subsequent to this the intensivist DC'd the hypothermia. I know I've also had patients on nimbex/propofol that became responsive, probably due to the dosage need of the drugs being relatively small s/p the code, but later on the patient is able to excrete/metabolize drugs better after recovering from the code.

Anyway...am I crazy here? If a patient became responsive...continue on with hypothermia and sedate/paralyze???

Specializes in MICU, SICU, CICU.

GCS > 5 is one of the exclusion criteria for TH.

Protocols || Center for Resuscitation Science || Perelman School of Medicine at the University of Pennsylvania

Specializes in Critical Care.

The purpose of therapeutic hypothermia is to optimize the neurological recovery potential, so if they are awake and following commands there is nothing to be gained from TH and it's use is no longer indicated, continuing TH on a patient who can follow commands has only the potential to cause harm and offers no benefits. It's an interesting bit of logic the people at your new facility is using, it's sort of like if you were transcutaneously pacing someone and then their own intrinsic heart rate comes back up and is competing with the pacer rate of 80, so instead of discontinuing the pacing, the patient is given a boatload of dilt so that their own normal heart rate stops interfering with the pacing.

If they are following commands after cooling has been initiated you will need to re-warm as hypothermia therapy would be a contraindication at this point. Why do you think we cool?

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