Hypothermic protocol patient

[andi.w]

We recently had a cardiac arrest patient that we placed in a hypothermic coma. After the 24hrs of cooling the patient, they began passively rewarming. The patient was very slow to rewarm, and after about 8hrs, the patient's temp had only increased by just about 1 degree Celsius. I know that these patients should be warmed slowly, but are there any adverse effects to warming them too slowly

[scrubsandasmile]

I think it would be worse to re-warm them too quickly..

[Altra, BSN, RN]

It sounds like either your rewarming order set needs to be fleshed out a bit, or the MD elected not to use it. Our order set/algorithm addresses which interventions to use at which time points to continue progressing with re-warming. Lots of web resources -- but your use of them will depend on your facility's protocols.

[prep8611]

We rewarm slowwwww so we won't make them code with all the shifting going on.

[prep8611]

We usually rewarm .25 to .5 degrees an hour. So ya one degree in 8 hours seems off.

[IABP4U]

Agree with the previous responses. ~ 0.5 degree/hour is ideal. Only 1 degree in 8 hrs...something isn't right. Are you using a topical vest, or endovascular cooling catheter? My facility uses the vest (unfortunately). If we have difficulty achieving our goal of 0.5 deg/hr, then our protocol allows for adding forced warm air (bair hugger), heat to the ventilator circuit, etc. In one case, a patient's temperature actually continued to decrease (mind you, this man was basically dead and probably wasn't the best hypothermia candidate to begin with). In that case, we had to run heated IV fluids.

[andi.w]

We regularly use an endovascular cooling catheter, but it was in use on another patient at the time. We used cooling blankets instead, which do not have the ability to rewarm. Apparently rewarming by room air with regular old warm blankets is the "old school" way of doing it, and I'm told usually does not take as long as in this particular case. The patient was actually only a little over 34 degrees Celsius when he arrived, so maybe he was already having difficulty regulating his body temp? I believe a Bair hugger was eventually placed to speed up the process. He was also probably not the best candidate, as he was down for about six minutes before resuscitation, and it was several hours before the hypothermic coma was initiated.

[Altra, BSN, RN]

Several hours post-arrest until cooling was initiated? Yikes - it sounds like this was mismanaged by your docs all the way around.