therapeutic cooling

[emmycRN]

I recently read that the NIH recommends cooling patients post cardiac arrest to improve outcomes (neuro).

So, are there any ICU nurses out there doing this? If so, what are your protocols and how do you achieve hypothermia (cooling blanket, fluids, ect).

Thanks in advance for sharing your knowledge on this topic!

[MichaelFloridaRN]

We have a separate CVICU and I work in SICU, so not sure about post cardiac surgery, however when we get patients post brain surgery we often get the order to keep temp at 97 F max. We keep it at that point with the use of a cooling blanket.

If you use one, then be sure to monitor the temp closely, because under-cooling can happen quickly and unexpected even after the patient has been "on ice" for several hours without incident.

[Diary/Dairy, RN]

We had a hypothermia protocol at my last perm. position, but did not use it a lot (maybe once a month at most)

I know it involved cooling them to maybe 92 degrees - don't quote me on that though - it's been a while - keeping them there for 24 hours and then slowly rewarming. We cooled them by using cooling blankets and using a temp. probe that was attached to the foley so we had a core temp. The temp was monitored constantly.

Sorry - that's the best I can come up with right now.

[Christie RN2006]

We just started using a hypothermia after cardiac arrest protocol. Right now our protocol is to maintain a body temp of 89-94 degrees and we use a rectal probe that constantly monitors their temperature. We use cooling blankets under and over the patient. Ice bags around the neck, under the arms and in the groin. Cooled IV fluids and Iced Saline lavages. The patient has to be sedated, paralyzed, and on the vent in order to do this because you do not want them to shiver. We keep them cooled for 24 hours and then rewarm them.

The patient has to meet really strict criteria in order for us to use this protocol.

[Altra, BSN, RN]

Our protocol in the ER is very similar to Christie RN2006's. On a sedated, paralyzed, intubated post-arrest patient we use ice around the neck, axilla and groin. The goal is 92 degrees. Patient's temp is continuously monitored via rectal temp probe.

When we get the patient up to the unit, they utilize cooling blankets underneath and on top of patient.

[nrsang97, BSN, RN]

Has anyone used the Alsius? We use it in my neuro ICU and it works well. It cycles cooled or warmed saline through a subclavian or femoral TLC with 2 extra lumens. We also use cooling blankets. We usually use this for neuro temps that aren't controlled with Tylenol and Motrin. We have a foley with temp probe so we always have core temp. Pt can be disconnected for travel if needed. Remember the football player last year that had the spinal cord injury? I believe they used this to cool him.

[emmycRN]

Thanks everyone for your replies, they were very helpful!! One more question-do you paralyze and intubate in order to start therapeutic hypothermia? Or, is this procedure only used if the patient needs to be mechanically ventilated anyway? Thanks again. :bowingpur

[Christie RN2006]

Thanks everyone for your replies, they were very helpful!! One more question-do you paralyze and intubate in order to start therapeutic hypothermia? Or, is this procedure only used if the patient needs to be mechanically ventilated anyway? Thanks again. :bowingpur

Generally if the patient has arrested they will be intubated. In order for us to use therapeutic hypothermia they do have to be intubated and sedated, it is one of the criteria. We will not intubate just to meet the criteria though.