Knight iv, md department of emergency medicine department of neurosurgery division of neurocritical care university of cincinnati ohio chapter of the american college of cardiology 20th annual meeting october 16, 2010. In studies of out of hospital cardiac arrest, induced hypothermia protocols have contributed to improved neurological outcomes. Recent studies using hypothermia have reported on patients with recovery of consciousness in spite of. Any potentially beneficial effects of hypothermia on neuronal recovery must be counterbalanced by the known adverse effects of hypothermia. In this issue of the journal, the reported results of two randomized clinical trials, one in australia1 and the other in europe,2 showed a neurologic benefit of mild therapeutic hypothermia 33c.
Hypothermia after cardiac arrest mgh stroke service. Post arrest hypothermia cardiac arrest is common 295,000 ohca per year in us 23% vf 31% bystander cpr median survival. Temperature management after cardiac arrest aha journals. Advanced age was not significantly associated with higher mortality, but elderly survivors were the least likely to experience a full or nearfull neurological recovery among all of. Just this week, a pt was post cardiac arrest, in a coma, and pupils were nonresponsive, no gag or cough reflex. Mildtomoderate induced hypothermia mih is effective in animal models. A guideline to direct evidencebased care to post cardiac arrest patients who remain comatose after return of spontaneous circulation.
However, induced mild hypothermia is not the sole treatment modality that we should use. This guideline should be used in conjunction with the targeted temperature management ttm orderset in penn chart. Post cardiac arrest hypothermia orange regional medical center. An expert panel recommends therapeutic hypothermia or targeted temperature management in comatose patients resuscitated after nontraumatic cardiac arrest, among other strategies to reduce brain. Abellas slides from his recent lecture highlights from the 2015 guidelines update at the hypothermia and. Present practice guidelines recommend sedativeanalgesic and neuromuscular. Beneficial effect of mild hypothermia and detrimental effect of deep hypothermia after cardiac arrest in dogs. An established hypothermia protocol, order set, and education program can be successfully implemented in any institution providing standardized care of post cardiac arrest patients. Neurological injury contributes to the mortality of inpatients post cardiac arrest in addition to multiple organ failure. Understand the rolesresponsibilities outlined in the abbott northwestern policy directing the care of the induced hypothermia therapy patient 2. Therapeutic hypothermia in cardiac arrest australian. Therapeutic hypothermia has been shown to improve both survival and neurological outcome for ohca patients surviving to reach the icu and now forms part of routine post resuscitation care.
Before the use of hypothermia as a treatment for comatose post cardiac arrest patients, several prognostic variables were widely accepted as reliable and valid for the prediction of poor outcome. Survival happens very rarely in a post cardiac arrest and of those who do survive there is however a high incidence of anoxic brain injury. Accidental hypothermia and cardiac arrest critcases em. Despite the publication of two randomized controlled trials of therapeutic hypothermia after cardiac arrest showing a clear benefit in neurologic outcome and mortality nearly a decade ago, the use. Diao m, huang f, guan j, zhang z, xiao y, shan y, et al. Therapeutic hypothermia protocol saves the brain after a cardiac arrest or heart attack. Mild therapeutic hypothermia to improve the neurologic. Post cardiac arrest therapeutic hypothermia in adult. Moderate hypothermia after cardiac arrest of 17 minutes in dogs. Dec 08, 2011 set up of the hypothermia blankets for post cardiac arrest cooling of patients. Cardiac arrest happens when the heart suddenly stops beating. In this article, we will discuss brain injuries that result from a persons cardiac arrest. Ttm protocol ttm should not delay imaging studies, continuous renal. Management of the postcardiac arrest patient is complex and must address.
Prehospital hypothermia induction for post cardiac arrest. The american heart association aha guidelines 2010 for post cardiac arrest care has emphasized on the use of therapeutic hypothermia as a neuroprotective therapy in adult post cardiac arrest victims whose initial cardiac rhythm is vfvt and who remain comatose gcs after rosc class i. Therapeutic hypothermia after cardiac arrest request pdf. Guidelines for use of hypothermia following cardiac arrest.
Data from adult patients admitted to our intensive care unit for a hypothermia protocol after cardiac arrest were recorded prospectively to generate a descriptive and analytical study analyzing the relationship between clinical, neurophysiological, imaging and biochemical parameters with 6month outcomes defined according to the cerebral performance categories scale good 12, poor 35. The role of eeg after cardiac arrest and hypothermia. Optimal management of shivering during therapeutic. Therapeutic hypothermia after cardiac arrest provides an evidencebased approach to identifying and managing cardiac arrest patients who are appropriate for th. You will need acrobat reader to view protocols in pdf format. Decreasing the temperature helps brain injuries after a cardiac arrest. An example of a hospitalbased protocol for therapeutic hypothermia th that summarizes.
Hypothermia after cardiac arrest guideline pdf authoring information. Cool it induced hypothermia therapy post cardiac arrest. In 2010, post resuscitation care was incorporated into the advanced life support section of the european resuscitation council erc guidelines. Therapeutic hypothermia after cardiac arrestpart 1.
Eligible and no contraindication for post cardiac arrest care protocol. Therapeutic hypothermia after cardiac arrest pdf clinical application and management if you found this book helpful then please like, subscribe and share. Therapeutic hypothermia after outofhospital cardiac arrest. Uphs post cardiac arrest targeted temperature management ttm clinical practice guideline purpose. Some of the clinical trials conducted in comatose postresuscitation cardiac arrest patients within the last decade have shown induced hypothermia to be. Naturally they differ significantly from patients with hypothermic cardiac arrest in the wilderness or during alpine accidents. Safely completed therapeutic hypothermia in postpartum cardiac arrest survivors. Hypothermia post cardiac arrest ccu coronary cardiac. 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. Postcardiac arrest care pathway draft 32306 hospital of. Therapeutic hypothermia after cardiac arrest springerlink. Normothermia versus therapeutic hypothermia for adult patients after cardiac arrest. Post cardiac arrest therapeutic hypothermia policy bcc0405 o insert foley with temperature probe. Resuscitated cardiac arrest continues to carry a poor prognosis despite advances in medical care.
Some of the patients were cooled at very low temperature and not on controlled settings. Anesthesia and analgesia protocol during therapeutic. The editor has assembled a team of prominent experts in the field to provide a practical howto book that presents the reader with the necessary tools to design, apply and. Therapeutic hypothermia after out of hospital cardiac arrest. Therapeutic hypothermia post outofhospital cardiac arrest. European resuscitation council and european society of. Consider termination of resuscitation as per your usual protocols rather than transfer in this case.
Therapeutic hypothermia protocol for cardiac arrest. Beyond hypothermia damon scales md phd department of critical care medicine. The role of hypothermia in postcardiac arrest patients with. Even when resuscitation efforts are successful, recovery is too often limited by post anoxic encephalopathy. Among these advances are the use of therapeutic hypothermia th and targeted temperature management ttm, along with other interventions to improve the care. No other patient, cardiac arrest or hypothermia protocol restrictions were applied. Targeted temperature management therapeutic hypothermia. Induced hypothermia therapy post cardiac arrest learning packet at the completion of this packet the learner will. In cardiac arrest, the heart suddenly stops beating. Approximately 530% of patients resuscitated from cardiac. Therapeutic hypothermia 538 hospitals participating in the get with the guidelines inhospital arrest database 20032009 67,498 patients who had return of spontaneous circulation after inhospital cardiac arrest. What is the clinical evidence for neurological benefits or harms of maintaining normothermia versus induction of therapeutic hypothermia in adult patients following cardiac arrest.
It involves lowering a patients body temperature in order to help reduce the risk of ischemic injury to tissues following a period of insufficient blood flow. Use of a nursing checklist to facilitate implementation of. Therapeutic hypothermia american heart association. Therapeutic hypothermia after outofhospital cardiac. To evaluate the association between therapeutic hypothermia treatment and survival outcomes, propensity score analyses were conducted. Therapeutic hypothermia after cardiac arrest circulation. Outofhospital cardiac arrest ohca is a leading cause of mortality and severe neurological disability. The use of therapeutic hypothermia after cardiac arrest in humans was described in 1950s, but with uncertain benefits.
Pdf on dec 31, 2015, jean baptiste lascarrou and others published therapeutic hypothermia for cardiac arrest. The effect of mild therapeutic hypothermia on renal function after cardiopulmonary resuscitation in men. Recent literature suggests that mild therapeutic hypothermia mth can improve survival and neurological outcome in some groups of comatose patients after cardiac arrest but uncertainty exists over the best way to implement this treatment. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study. Hypothermia or strict normothermia after cardiac arrest.
Anesthesia and analgesia protocol during therapeutic hypothermia after cardiac arrest. Postcardiac arrest care pathway draft 32306 hospital of the university of pennsylvania page 1 of 14 postcardiac arrest care pathway page 2 equipment list page 3 logistical pearls regarding therapetuic hypothermia. Patients who meet inclusion criteria post cardiac arrest should have their core body temperature reduced to. Hypothermia tempers the postca syndrome inflammatory cascade and aborts activated programmed cell death pathways by reducing the. Cardiac arrest patients aged 75 years, a demographic excluded from the hypothermia after cardiac arrest clinical trial, 6 comprise 21% of cool it patients to date. However, advances in cardiopulmonary resuscitation and post cardiac arrest care have improved outcomes in select cohorts of patients. Confusion around therapeutic temperature management. Therapeutic hypothermia post outofhospital cardiac arrest more.
Hyperthermia following cardiac arrest 83% of cardiac arrest patients develop fever1. Two landmark randomized controlled trials, both reported in 2002. Post cardiac arrest therapeutic hypothermia in adult patients. Uphs post cardiac arrest targeted temperature management. Chain of survival the chain of survival as advocated by the various societies of resuscitation. Prehospital therapeutic hypothermia after cardiac arrest. Patients post outofhospital cardiac arrest ohca are common admissions to the icu. Dec 01, 20 an information update the australian resuscitation council arc recommends the use of therapeutic hypothermia as part of a care bundle in the post arrest management of unconscious patients following cardiac arrest. Pdf on nov 17, 2014, kees polderman and others published therapeutic hypothermia in postcardiac arrest find, read and cite all the research you need on researchgate. Abellas slides from his recent lecture highlights from the 2015 guidelines update at the hypothermia and resuscitation training hart institute at penn. Seder and others published shivering during therapeutic hypothermia after cardiac arrest find, read and cite all the research you need on researchgate. Background no proven neuroprotective treatment exists for ischemic brain injury after cardiac arrest.
Md, mphfrom the levine cardiac intensive care unit, cardiovascular division, department of medicine, brigham and womens hospital and harvard medical school, boston, ma. New aan guideline on neuroprotection after cardiac arrest. For each celsius degree higher than 37c, the risk of an unfavorable neurologic recovery increases. Those unresponsive within a sixhour post cardiac arrest. No order, protocol or guideline can anticipate every clinical circumstance, nor are they meant to substitute clinical assessment and judgment. Definition therapeutic hypothermia is the process of cooling the body by reducing body temperature to 32. Does anyone know of any ems services in the united states that are doing prehospital hypothermia induction for post cardiac arrest resuscitation. Once the heart starts beating again, healthcare providers use cooling devices to lower your body temperature for a short time. After the initial 48 hours after resuscitation, most patients showed a rapid rise in body temperature2.
Patients who have been shown to benefit from induced hypothermia include. Set up of the hypothermia blankets for post cardiac arrest cooling of patients. I am only familiar with three, regional one air medical in spartanburg, south carolina, seattle fire departmentking county medic one and. Therapeutic hypothermia after cardiac arrest american nurse. Therapeutic hypothermia is recommended for comatose adults after witnessed outofhospital cardiac arrest, but data about this intervention in children are limited. Therapeutic hypothermia after cardiac arrest johns. While there has been debate about which cooling protocol is best, our guideline. Trauma center guidelines for use of hypothermia following adult cardiac arrest inclusion criteria sustained cardiac arrest related to ventricular tachycardia, ventricular fibrillation, pulseless electrical activity or asystole.
Only one third of patients admitted to the hospital. Targeted temperature management ttm or therapeutic hypothermia th is currently one of the most important methods of neuroprotection. One such advance, therapeutic hypothermia, is neuroprotective and has been demonstrated to improve clinical outcomes in patients who remain unresponsive despite return of spontaneous circulation after arrhythmogenic cardiac arrest. May, 2017 the guideline found strong evidence that for patients who are treated with electric shocks to the heart after outofhospital cardiac arrest and who are in a coma, cooling the body down to 89. Although survivors of vf cardiac arrest have the most to gain from therapeutic hypothermia, some. Therapeutic hypothermia after prolonged cardiac arrest. Hypothermia protocol external cooling device therakool sedation with midazolam and fentanyl.
Do not delay tests or post arrest procedures to initiate cooling. Its sometimes used for people who have a cardiac arrest. Therapeutic hypothermia after resuscitated cardiac arrest the purpose of this protocol is to improve the neurologic outcomes of patients who have experienced cardiac arrest and have been successfully resuscitated. Google scholar leonov y, sterz f, safar p, radovsky a. No single physical finding or test can predict neurologic recovery after cardiac arrest with 100% certainty. Methods and results a safety and feasibility trial was designed to evaluate mildtomoderate induced hypothermia by use of external cooling blankets after cardiac arrest. Shivering during therapeutic hypothermia after cardiac arrest.
It provides a rationale for the different treatment steps of a standardized treatment protocol for post cardiac arrest patients see table 1. Administer per icu protocol critical care nursing policy ccc0505. Bray je, stub d, bloom je, segan l, mitra b, smith k, finn j, bernard s. Witnessed cardiac arrest patients, most commonly with vf or pulseless vt, constitute the optimal patient population for this therapy as it is known with some certainly how long the patient was down. When shivering occurs regardless of optimal sedation, many therapeutic hypothermia protocols recommend use of a paralytic agent ie, a neuromuscular blocker to control shivering. May 10, 2017 body cooling may help brain after cardiac arrest. This site is intended for use by physicians, nurses and other health care providers who are interested in the care of patients after they are resuscitated from cardiac arrest. There are a plethora of reasons for someone to sustain a brain injury.
Normothermia versus therapeutic hypothermia for adult. Multiple modalities of testing and examination used together to predict outcome after the effects of hypothermia and medications have been allowed to resolve, are most likely to part 8. Therapeutic hypothermia after resuscitated cardiac arrest. A multivariable logistic regression model was constructed to estimate a patients likelihood of being treated with therapeutic hypothermia after inhospital cardiac arrest. Therapeutic hypothermia after inhospital cardiac arrest circulation. Outofhospital cardiac arrest claims 225,000 lives each year in the united states and a similar number in europe, accounting for about half of all deaths due to cardiovascular disease. Altogether 176 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. Postcardiac arrest caretherapeutic hypothermia resources. Prior to making any medical decisions, please view our disclaimer. Backgroundtherapeutic hypothermia is recommended for comatose adults after witnessed outofhospital cardiac arrest, but data about this intervention in children are limited. After an eeg, and echo, the docs determine that this pt was a canditate for hypothermia. As hypothermia becomes severe, myocardial irritability increases, with a risk for arrhythmia and cardiac arrest most significant below 28 o c. The use of moderate hypothermia after cardiac arrest was initially reported in the late 1950s and early 1960s.
Post cardiac arrest hypothermia, or therapeutic hypothermia also called targeted temperature management is a type of cardiac treatment for patients who have experienced cardiac arrest which is when the heart suddenly stops beating. Causes of accidental hypothermia leading to cardiac arrest in a city are mostly intoxications, very severe disease and socioeconomic catastrophes. The use of mth as a tool to reduce cerebral oxygen demand and to improve neurological outcomes after cardiac arrest was supported by studies in dogs. The investigators who participated in the hypothermia after cardiac arrest study group are listed in the appendix.
Cardiac arrest results in over 500,000 deaths per year in north america alone. Urine output changes during postcardiac arrest therapeutic. Therapeutic hypothermia after outofhospital cardiac arrest in children. The hypothermia protocol, in my understanding, is primarily to preserve brain function. Continuous eeg in therapeutic hypothermia after cardiac arrest. Intubated patients with treatment initiated within a 6hour post cardiac arrest nonperfusing ventricular tachycardia vt or ventricular fibrillation.
Hypothermia protocol and saving the brain after a cardiac. Best practices 2014 deborah klein, rn, msn, acnsbc, ccrn, chfn, faha clinical nurse specialist coronary icu, heart failure icu, and cardiac short staypacucaru. Use of a nursing checklist to facilitate implementation of therapeutic hypothermia after cardiac arrest article in critical care nurse 351. Therapeutic hypothermia also called targeted temperature management refers to deliberate reduction of the core body temperature, typically to a range of about 32 to 34 c 89. Postcardiac arrest care american heart association. Therapeutic hypothermia in the emergency department following. Nair su, lundbye jb 20 the occurrence of shivering in cardiac arrest survivors undergoing therapeutic hypothermia is associated with a good neurologic outcome. Pdf therapeutic hypothermia after cardiac arrest researchgate. 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.