Hypothermia protects the brain and other vital organs and has been shown to. At 18 hours, patients were actively rewarmed over 6 hours. Hypoxicischemic encephalopathy hie therapeutic hypothermia admission eligibility. Therapeutic hypothermia after outofhospital cardiac arrest. Mild therapeutic hypothermia technical medical information about hypothemia and related conditions. 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. If normal x 2 without replacement, discontinue coagulation profile monitoring. Members of the providing institutions have agreed to share their work for the sake of improving postresuscitation care. Of the 27 pts in this case report,2 failed to get rosc, 6 had no coma and were excluded from the analysis. Jul 26, 2019 targeted temperature management ttm, previously known as mild therapeutic hypothermia, in selected patients surviving outofhospital sudden cardiac arrest ohca can significantly improve rates of longterm neurologically intact survival, and it may prove to be one of the most important clinical advancements in the science of resuscitation. In february 2011, national health service nhs national. Our objective was to compare two target temperatures, both intended to prevent fever. Carpenter christine lesch emily gilmore rishi malhotra stephan a.
More recently, the benefits of induced therapeutic hypothermia have been. Anesthesia and analgesia protocol during therapeutic hypothermia after cardiac arrest. Therapeutic hypothermia after cardiac arrest jama jama. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services and structure, and clinical information. The next steps of therapeutic hypothermia ottawa heart institute. Class 1 recommendation to initiate therapeutic hypothermia th in. Induction all patients if temp endotracheal tube placement per standard protocol. Each patient should be observed closely for shiver. Of the 19 remaining, 12 received hypothermia and 7 did not. Application of therapeutic hypothermia in the intensive. Hypothermia physiology, signs, symptoms and treatment.
The most commonly used definitions found in the literature are as follows. The more recent use of therapeutic hypothermia after cardiac arrest to improve neurological recovery was instituted globally after publication of 2 landmark studies 2,3 in 2002. 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. Prehospital therapeutic hypothermia after cardiac arrest. Post cardiac arrest therapeutic hypothermia in adult. Although the latter remains in question, the pathogenesis of brain injury evolves over an extended interval of days.
Infants treated with systemic hypothermia have a lower incidence of cortical neuronal injury on mri. The american college of cardiologyamerican heart association guidelines include a. Outcomes evaluated included time to target core body temperature, therapeutic hypothermia protocol initiation. Cbc, bmp, mg, phos, ptpttinr, troponin, ecg, cxr if female.
There are some cases in which hypothermia is induced for the patients treatment. Therapeutic hypothermia has been shown to be neuroprotective and to reduce mortality in victims of cardiac arrest what. Therapeutic hypothermia and temperature management mary. Foley with termister or esophageal temperature probe. 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. Original article prevention of shivering during therapeutic temperature modulation. The center for resuscitation science based in the department of emergency medicine at the university of pennsylvania is dedicated to research and training that will save the lives of people who suffer cardiac arrest and shock. Following these reports, therapeutic hypothermia finally took its due place in postresuscitation guidelines. During therapeutic hypothermia th, also known as medically induced hypothermia or targeted temperature management, doctors lower oxygen demand in the brain by reducing a patients body temperature to moderate hypothermic levels, thereby lowering the likelihood of cellular damage sources.
Cvp or pa catheter preferably positioned in the subclavian vein arterial pressure line. The disorder hypothermia is defined as a core temperature of less than 35 degrees celsius. The alsius icy catheter is only intended for placement in the femoral vein. Toby protocol, in infants from 3444 weeks gestation, without apparent adverse events and with an improvement in their encephalopathy score. Advanced practice registered nurses on therapeutic. Its sometimes used for people who have a cardiac arrest. Protocol for therapeutic normothermia with raprround wraps.
Hypothermia protocol and saving the brain after a cardiac arrest. Mild therapeutic hypothermia in patients resuscitated from outofhospital cardiac arrest. Sep 16, 2016 systemic hypothermia more uniform cooling of the brain and deeper cns structures. Approximately 530% of patients resuscitated from cardiac. Therapeutic hypothermia cooling blanketstop and bottom sandwich 6. Request pdf therapeutic hypothermia protocols the application of targeted temperature management has become common practice in the neurocritical care setting. Best practice in a community hospital survival rates prior to the era of therapeutic hypothermia ranged from 9% to 11% for allrhythm cardiac arrest and 19% to 21% for primary ventricular fibrillation.
All interviews were conducted by telephone by a clinician and a qualitative researcher. Hypothermia is defined as a core temperature less than 36oc 96. Bladder lavage to be used only if cooling process not successful within 1530 minutes 9. Probable perinatal asphyxia less than 8 hours of age moderate or severe encephalopathy no unstable coagulopathy or persistent pulmonary hypertension of the newborn pphn patient care therapeutic hypothermia protocol. Therapeutic hypothermia after cardiac arrestreply paul s. However, establishment of the optimal therapeutic hypothermia protocol and management of adverse effects, such as shivering, that counteract the benefits of therapeutic hypothermia, have yet to be determined. Guideline for the use of neonatal therapeutic hypothermia. Therapeutic hypothermia frequent vital sign sheet cooling the patient in the first 4 hours 1. Studies have shown that implementation of mild therapeutic hypothermia seems to improve survival and neurological outcome after 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 hypothermia therapy post cardiac arrest learning packet at the completion of this packet the learner will. Similarly nice guidelines for the use of therapeutic hypothermia in cardiac arrest have also recently been published 4.
An example of a hospitalbased protocol for therapeutic hypothermia th that summarizes key steps for initiation and implementation of hypothermia. Cardiac arrest results in over 500,000 deaths per year in north america alone. Phyllis robinson msn, rn june 10, 2018 0 comments 919. Mild hypothermia alters midazolam pharmacokinetics in normal healthy volunteers. Do not begin cooled infusion until cooling devices are assembled 2. Understand the rolesresponsibilities outlined in the abbott northwestern policy directing the care of the induced hypothermia therapy patient 2.
Surface cooling protocols to induce and maintain therapeutic hypothermia after. Targeted temperature management therapeutic hypothermia. Prevention of shivering during therapeutic temperature. Spertus, md, mph to the editor dr chan and colleagues 1 evaluated the association between therapeutic hypothermia and survival to hospital discharge in patients with inhospital cardiac arrest and found lower survival among patients treated with therapeutic. Cooling criteria protocol same between treatment periods gentamicin monitoring. Shiver is a major clinical issue in active normothermia maintenance. 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.
The protocol encompasses several important treatment points. Therapeutic hypothermia protocol saves the brain after a cardiac arrest or heart attack. In any type of brain injury, in particular, in patients with fever or hyperpyrexia respectively, injured areas may be definitely hotter up to 2c. 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. Hypothermia facts hypothermia occurs when heat escapes from your body faster than it can warm itself.
Application of therapeutic hypothermia in the intensive care unit. Vecuronium is drug of choice in this protocol due to its lack of adverse cardiac effects. Pdf therapeutic hypothermia after cardiac arrest researchgate. Therapeutic hypothermia american heart association. 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. Post cardiac arrest targeted temperature page 1 of 10. Once the heart starts beating again, healthcare providers use cooling devices to lower your body temperature for a short time. Optimal management of shivering during therapeutic. Therapeutic hypothermia is a procedure used to cool a persons body to a temperature that is lower than normal.
Pdf prognosis following outofhospital cardiac arrest is generally poor. Post resuscitation care therapeutic hypothermia post resuscitation care is a new protocol for the maine 20 protocols. Therapeutic hypothermia hypothesized benefits include. The purpose of this protocol is to provide guidelines for the application of mild therapeutic hypothermia to comatose survivors of cardiac arrest in an attempt to improve neurologic outcomes. The procedure is done after a cardiac arrest when the heart stops that happens outside of a healthcare setting. Since hypothermia is now standard of care for moderatesevere hie, hard to determine if pk changes. Obtain a core temperature via esophageal, bladder or rectal temperature probe. Targeted temperature management ttm or therapeutic hypothermia th is currently one of the most important methods of neuroprotection. Early screening and identification of candidates for. However, to date, no therapeutic intervention has been demonstrated to definitively. Challenges in providing therapeutic hypothermia as standard of care there are significant challenges in the identification of newborns likely to benefit from. Nevertheless, the application of systematic protocols of cooling has not been adequately reached in many hospitals. The role of eeg after cardiac arrest and hypothermia.
Therapeutic hypothermia protocol in a community emergency. Therapeutic hypothermia and temperature management ahead of. Clinical pearls during hypothermia nmb, opioids and sedatives tend to have a longer duration of activity than in patients that are normothermic. Each link below will open a file containing the therapeutic hypothermia protocol from the institution shown. Nice have also produced guidance on therapeutic hypothermia for clinicians ipg. This is a pdf file of an unedited manuscript that has. Laboratory monitoring while receiving therapeutic hypothermia. Hypothermia, drowning and coldwater survival if you cant get out in 515 minutes, you might not get out on your own power. Pdf clinical studies and experimental research have described therapeutic hypothermia for patients suffering from traumatic brain injury tbi. Th gained recognition in the past 6 years as a neuroprotective. Many variables contribute to the development of hypothermia. Hypothermia hypothermia center for resuscitation science.
Diao m, huang f, guan j, zhang z, xiao y, shan y, et al. The stage of hypothermia, defined by core temperature, has a large impact on both recognition and treatment. Patients randomized to normothermia were maintained at 37 c. However, advances in cardiopulmonary resuscitation and postcardiac arrest care have improved outcomes in select cohorts of patients. Hcg replete electrolytes if needed sedation with midazolam and fentanyl, goal ramsay 5 turn off room thermostat remove. Check back often, as we hope to add new protocols frequently. Villablanca, mohammed makkiya, evann einsenberg, david f. Each ceeg file was analyzed using standard definitions to define ncse. Hypothermia n7 normothermia n8 methods hypothermia protocol external cooling device therakool sedation with midazolam and fentanyl pancuroniumto prevent shivering target temperature of 32c to 34c for 24h passive rewarming over 8h initiation of cooling target temp 3234c rewarmed 0h jan 16, 2014 therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Therapeutic hypothermia protocol for cardiac arrest. Therapeutic hypothermia is also called induced hypothermia. Bernard et al 2 and the hypothermia after cardiac arrest study group 3 corroborated positive outcomes in patients with ventricular fibrillation.
Mild therapeutic hypothermia after cardiac arrest protocol. Alex choi sangbae ko mary presciutti luis fernandez amanda m. Decreasing the temperature helps brain injuries after a cardiac arrest. Active surface cooling protocol to induce mild therapeutic hypothermia after outofhospital cardiac arrest. Post cardiac arrest therapeutic hypothermia in adult patients, state of. Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using icecold ringers solution. Hypothermia is also considered the clinical state of subnormal temperature when the body is unable to generate sufficient heat to efficiently maintain functions. This medical treatment is performed to decrease the chances of obtaining ischemic tissue injury due to impairment of blood flow.
Interviews were recorded electronically and transcribed unless the participant declined to have the interview recorded. Protocols hypothermia center for resuscitation science. Therapeutic hypothermia after resuscitated cardiac arrest. Due to the ongoing risk of cerebral hemorrhage, consider transfusing at a threshold platelet count of 50k. Conclusionsa comprehensive th protocol can be integrated into a regional stsegment elevation myocardial infarction network and achieves broad dispersion of this essential therapy for ohca. Hypothermia has been shown to reduce ischemia induced inflammatory and immune reactions 4, 1922. Therapeutic hypothermia has emerged as a potentially lifesaving treatment for the care of the critically ill. Therapeutic hypothermia can significantly reduce mortality and improve neurological outcomes in comatose survivors of sudden cardiac arrest. Among these advances are the use of therapeutic hypothermia th and targeted temperature management ttm, along with other interventions to improve the care.
In the united states, the american heart association recommends hypothermia as a standard of care for survivors of cardiac arrest 5 as there. Caring for patients treated with therapeutic hypothermia. This trial protocol has been provided by the authors to give readers additional information about their work. Post cardiac arrest targeted temperature page 2 of 10 management ttm disclaimer.
Criteria for therapeutic hypothermia cooling queensland clinical guideline. Meditherm iii hypothermia machine with 2 sets of hoses and one set of raprround wraps torso and legs x 2 tpad and tpump. Hypothermia information about preventing and treating hypothermia. Mild hypothermia core temperature 32 to 35c 90 to 95f moderate hypothermia core temperature 28 to 32c 82 to 90f. Induction of prehospital therapeutic hypothermia after resuscitation from nonventricular fibrillation cardiac arrest. Recently, the use of therapeutic hypothermia has gradually occupied an.
The goal of therapy is to achieve and maintain mild therapeutic hypothermia for a 24 hour period with a target range of 3234c. We evaluated the effects of using a th protocol in a large community hospital emergency department ed for all patients with neurological impairment after resuscitated ohca regardless of presenting rhythm. Cardiac arrest happens when the heart suddenly stops beating. There are a plethora of reasons for someone to sustain a brain.
Perceived barriers to therapeutic hypothermia for patients. Pdf therapeutic hypothermia has been used for millennia, but in recent. Therapeutic hypothermia is associated with a decrease in. Managing the airway and keeping the o2 sat greater or equal to 94% while at the same time being cognizant to prevent excessive ventilations and hyperoxia.
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. Pioneer works on therapeutic hypothermia th half a century ago. 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, when initiated within no more than 6 hours following resuscitation, is an established means of protecting neurologic functioning in adult. Ventilator setting as appropriate for the patients presenting condition. Monitoring for nmbtrainoffour monitoring using a peripheral nerve. Each year, approximately 1500 patients in the united states have hypothermia noted on their death certificate. The cause of hypothermia is the inability of the bodys temperature regulation system to keep the bodys core temperature between 35. Therapeutic hypothermia australian resuscitation council. Therapeutic hypothermia after cardiac arrest johns.
Cool it induced hypothermia therapy post cardiac arrest. Timing of percutaneous coronary intervention and therapeutic. The unconscious person is cooled in the hospital after his or her breathing and heartbeat start again. Pdf therapeutic hypothermia past, present, and future. Does baby meet criteria for probable moderate or severe hie i. Effects of therapeutic hypothermia on physiologic determinants of drug pharmacokinetics and pharmacodynamics reduced activity of hepatic enzymes eg. Protocol this trial protocol has been provided by the authors to give readers additional information about their work. Neurocare associates 2101 medical park drive, suite 305 silver spring, maryland 20902 301 7540833.
Demographics and other clinical data ere collected. Hypothermia definition, stages, causes, treatment protocol. Induction and maintenance of therapeutic hypothermia after. Therapeutic hypothermia is the process of cooling the body by reducing body temperature to 32. Novel findings from translational preclinical investigations as well as clinical studies and trials will be featured. Page 1 of 12 adult therapeutic hypothermia protocol. Therapeutic hypothermia and post cardiac arrest survival.