Therapeutic hypothermia th improves neurological recovery and reduces mortality after global ischemia, such as in patients with cardiac arrest, and in infants with moderate or severe hypoxicischemic encephalopathy 4. The therapeutic effects of hypothermia were discussed as early as 400 bc when hippocrates mentions the use of snow and ice to reduce hemorrhage in patients 5. Therapeutic hypothermia after cardiac arrest aha journals. Hypothermia physiology, signs, symptoms and treatment. Mild hypothermia alters midazolam pharmacokinetics in normal healthy volunteers. Patients were included regardless of initial arrest location outofhospital or inhospital. Induced hypothermia therapy post cardiac arrest learning packet. Adjust set temperature to maintain rectal temperature in the range of 33. Cpr performed prior to rosc should not stop reperfusion therapy. Accidental hypothermia rebel em emergency medicine blog. Induced hypothermia therapy post cardiac arrest learning packet at the completion of this packet the learner will. Minimum room temperature will be set in discussions with surgeons.
Clinical applications of induced hypothermia bja education. Handle people with hypothermia gently because their skin may be frostbitten, and rubbing frostbitten tissue can cause severe damage. Mild hypothermia core temperature 32 to 35c 90 to 95f moderate hypothermia core temperature 28 to 32c 82 to 90f. Hypothermia treatment must be carefully implemented due to the potential for adverse effects. Post cardiac arrest care induced hypothermia pathway order set. Therapeutic hypothermia also called targeted temperature management is now recommended in international resuscitation guidelines, and its use has been extended to cardiac arrest of other causes. Page 1 of 12 adult therapeutic hypothermia protocol.
We assessed the feasibility, effectiveness, side effects, and adverse events associated with a standardized surface cooling protocol. Induced hypothermia and fever control for prevention and treatment of neurological injuries. Hypokalemia during the cooling phase of therapeutic hypothermia and its impact on arrhythmogenesis sultan a. Induction of prehospital therapeutic hypothermia after resuscitation from nonventricular fibrillation cardiac arrest. Targeted temperature management ttm previously known as therapeutic hypothermia or protective hypothermia is an active treatment that tries to achieve and maintain a specific body temperature in a person for a specific duration of time in an effort to improve health outcomes during recovery after a period of stopped blood flow to the brain.
Induced therapeutic hypothermia after pediatric cardiac arrest is an important intervention. Page 4 of 11 hypothermia prevention, monitoring, and management appendix a 1. Management of a patient receiving induced hypothermia per arctic. If history of chf then 1 liter bolus reassess temperature postresuscitation. In 1930s1940s, hypothermia in cancer patients in 1950s, induced th was widely used during head spinal cord injuries and cardiac surgery in 1959, benson et al. Toby protocol, in infants from 3444 weeks gestation, without apparent adverse events and with an improvement in their encephalopathy score. Therapeutic hypothermia after resuscitated cardiac arrest. For our th protocol we use an endovascular cooling catheter icy catheter, ic3893, alsius, irvine ca with the goal to cool the patient to a target temperature of 33 c within four hours.
Therapeutic hypothermia protocol for cardiac arrest patient selection patients who present to the emergency department ed or critical care unit ccu after cardiac arrest in or out of hospital who have a return of spontaneous circulation rosc and have the following conditions should be considered for this protocol. Therapeutic hypothermia protocol in a community emergency. Michael feldman discuss the removal of atropine from the peaasystole algorithm, the indications and dangers of adenosine in widecomplex tachycardias, pressors as a bridge to transvenous pacing in unstable bradycardias, and the key elements of post cardiac arrest care. The management of hypothermia depends on its severity. Therapeutic hypothermia american heart association. Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using icecold ringers solution. This neurological assessment will direct inclusionexclusion of the patient for induced hypothermia per protocol.
Place indwelling rectal or esophageal temperature probe. Therapeutic hypothermia is the process of cooling the body by reducing body temperature to 32. All cases will be done in rooms with working temperature controls. Therapeutic hypothermia protocol for cardiac arrest. Therapeutic hypothermia is also called induced hypothermia.
Induced hypothermia also may be considered for comatose adult patients with rosc after inhospital. Hypothermia treatment has also shown positive effects in neurological outcomes of cardiac arrest patients. If criteria are met, the patient is cooled using the induced hypothermia protocol for 24 hours to a goal temperature of 3234 c 8993 f. The mean qtc at baseline was 47843 ms, during hypothermia 52865 ms p 0. Therapeutic hypothermia does not appear to provide a survival or improved neurological benefit in both studies, no difference in survival, function at 12 months postarrest, blood product use, infection rates. Discuss case with icu fellow or attending they must agree with the plan for hypothermia. Anesthesia and analgesia protocol during therapeutic hypothermia after cardiac arrest. What is the desired outcome of induced hypothermia. The cause of hypothermia is the inability of the bodys temperature regulation system to keep the bodys core temperature between 35. Care and facilityunit protocol for responding to cardiopulmonary arrest. Relative contraindications to therapeutic hypothermia 1. Foley with termister or esophageal temperature probe. Hypothermia may be present regardless of temperature if the patient describes feeling cold or presents with common signs and symptoms of hypothermia, such as, shivering, peripheral vasoconstriction, and piloerection. Moderate, severe or extreme hypothermia 32 c, or 90 f rectal, vesical thermistor bladder catheter, and confirmed esophageally core temperature.
Nice have also produced guidance on therapeutic hypothermia for clinicians ipg. Rewarming of the severe hypothermia patient is best carried out in a hospitals emergency room using a predefined protocol. Notify trauma teampediatric surgery service level i trauma. If available, cold saline bolus 20 mlkg to max of 2 liters. Complete baseline nursing assessment which includes a neuro assessment.
Mssm ed critical care induced hypothermia protocol place. If the patient returns to the ed, hook the machine back up. Understand the rolesresponsibilities outlined in the abbott northwestern policy directing the care of the induced hypothermia therapy patient 2. Temporal trends in the use of therapeutic hypothermia for outofhospital cardiac arrest. Hypothermia has been shown to reduce ischemia induced inflammatory and immune reactions 4, 1922. The role of hypothermia in postcardiac arrest patients with return of spontaneous circulation. Bladder lavage to be used only if cooling process not successful within 1530 minutes 9. The role of hypothermia in postcardiac arrest patients. The most commonly used definitions found in the literature are as follows.
Nolanc a intensive care medicine, royal united hospital, bath ba1 3ng, uk b director of medical education, royal melbourne hospital, university of melbourne, australia. Hypokalemia during the cooling phase of therapeutic. D associate professor of pediatrics division of neonatology. Cardiac arrest with return of spontaneous circulation rosc in or out of the hospital, any gender initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia note. In any type of brain injury, in particular, in patients with fever or hyperpyrexia respectively, injured areas may be definitely hotter up to 2c.
Hypothermia is defined as a core temperature less than 36oc 96. The alsius icy catheter is only intended for placement in the femoral vein. Therapeutic hypothermia hypothesized benefits include. The best studied parameter of hypothermia regimens among perinatal animals was the time to initiate cooling. Qt prolongation during therapeutic hypothermia of sudden. Apr 18, 2011 discussion of induced hypothermia post cardiac arrest in comatose patients. Cvp or pa catheter preferably positioned in the subclavian vein arterial pressure line.
Each link below will open a file containing the therapeutic hypothermia protocol from the institution shown. Check back often, as we hope to add new protocols frequently. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The patient if not already should be intubated and mechanically ventilated, maintaining a p o 2. Meditherm iii hypothermia machine with 2 sets of hoses and one set of raprround wraps torso and legs x 2 tpad and tpump. An australian intensive care unit, where a second trial 3 showed similar benefits of hypothermia after oohca, used the following protocol once a patient was to be cooled after cardiac arrest. Hypothermia protocol for barnesjewish hospital inclusion criteria. Cool it induced hypothermia therapy post cardiac arrest. Any local ems system changes to this document must follow the nc oems protocol change policy and be approved by oems. Many variables contribute to the development of hypothermia. Induced hypothermia rationale use of hypothermia treatment decreases the severity of ischemic brain damage and leads to improved neurological outcomes at 6 months after cardiac arrest and has also been shown to be effective for refractory intracranial pressure icp elevations ethical considerations. Hypothermia definition, stages, causes, treatment protocol. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext.
Therapeutic hypothermia in the newborn date of publishing. Targeted temperature management at 33c versus 36c after. Induced hypothermia in trauma article pdf available in journal of the intensive care society 124. Each institution shall adopt a process and standardized tool to trigger therapeutic hypothermia when that is determined by a licensed independent provider to be the appropriate treatment for any neonate at or past 34 weeks gestation with findings of neonatal encephalopathyor considered at risk for encephalopathy or a seizure event per screening criteria. The hypothermia target is maintained for 24 hours starting at the time from initiation of therapy. Induced hypothermia history ynontraumatic cardiac arrest drowning and hanging are permissible in this protocol signs and symptoms. The stage of hypothermia, defined by core temperature, has a large impact on both recognition and treatment. A coherent hypothermia prevention and reversal strategy is required during stages of combat casualty care. Meets criteria for induced hypothermia advanced airway in place airway management king ltsd, ett protocol perform neuro exam expose patient, apply ice packs around the head, to the groin, and axilla.
Induction and maintenance of therapeutic hypothermia after. Therapeutic hypothermia will be induced for up to 24 hours, and then the patient will be slowly rewarmed to bring safely back to normothermia. The acmc protocol design is based on the methods used in the two above studies and also incorporates features from. Hypothermia protocols perelman school of medicine at the. Hypothermia reduces cerebral metabolic demand by 6% for every 1. This increase in qtc interval during the cooling phase was similar in both genders. Protocols hypothermia center for resuscitation science. Bradley, wenhui liu, bryan mcnally, kimberly vellano, timothy d. Neurologic prognostication and bispectral index monitoring. Therapeutic hypothermia frequent vital sign sheet cooling the patient in the first 4 hours 1. Guideline for the use of neonatal therapeutic hypothermia. The patient was than transferred to the micu where the th protocol with target core body temperature of 33. Hypothermia increments use caution if rales present special considerations if hypothermia is suspected, defibrillate only once, administer only one dose of epinephrine and no other medications should be administered until the patient is rewarmed.
Members of the providing institutions have agreed to share their work for the sake of improving postresuscitation care. The disorder hypothermia is defined as a core temperature of less than 35 degrees celsius. The goal is to begin cooling as soon as absolutely possible, but no later than 6 hours after rosc. The following outlines general recommendations on how to use specific products at the various levels of care found on the battlefield. Gestational age greater than or equal to 35 weeks gestation 2.
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