Imperial Valley Evidence-Based Practice Conference Induced Hypothermia in Post Cardiac Arrest Adults

1. Imperial Valley Evidence-Based Practice ConferenceInduced Hypothermia in Post Cardiac Arrest Adults • Intervention • Within the first 15 minutes in Return of Spontaneous Circulation (ROSC): • Stabilize cardio-respiratory system • Goal: MAP > 75mmHg • Goal: O2 sat > 98% • Conduct a baseline neurological exam • Communicate induction of hypothermia to critical care team • Sedation and paralysis • Initiate therapeutic hypothermia with target temperature of 32-34˚C (89.6-93.2˚F) within 2-6 hours: • Expose patient to ambient air • Ice packs to head, axillae, and groin • Wet sheet and fan • Cold saline infusion • Cooling blanket • Once target temperature of 32-34˚C is reached: • Continue with paralysis and sedation • Remove ice packs and maintain cooling blanket for 24 hours • After 24 hours passive re-warming • Taper paralytics and sedation then reassess neurological function • (Green & Howes, 2005) • Future Implications • PMH is currently budgeting for an Arctic Sun which cools and rewarms the patient in a controlled manner, though cooling can be just as effective using ice packs • The Arctic Sun can also be used to treat hyperthermia, which is very common in the IV • A team at PMH is currently working on protocols • A weakness to the process is the limited number of patients who would meet the criteria • Practice Problem • 74-87% of adults in post cardiac arrest have poor neurological outcomes including death ) • PICO • Does induced hypothermia or maintained normothermia decrease neurological damage in post cardiac arrest adults? Presented by: Robyn Atadero RN, BSN Pioneers Memorial Hospital ratadero@phmd.org • Innovation /Improvement • Implement therapeutic hypothermia in post cardiac arrest patients, who meet criteria, using cooling devices • Literature Cited • American Heart Association. (2005). Part 7.5: • Post resuscitation support. Circulation: Journal of • the American Heart Association. 112, IV-84 – • IV-88. • Bernard, Buist, Gray, Gutteridge, Jones, Silvester, • & Smith (2002). Treatment of comatose survivors of • out-of-hospital cardiac arrest with induced • hypothermia. New England Journal of Medicine. • 346(8), 557-563.  • Bernard, Holzer, Mullner,, & Roine(2003). • Hypothermia for neuroprotection after c • cardiopulmonary resuscitation (protocol). Cochrane • Database of Systematic Reviews, 2, 1-10.  • Green & Howes(2005). Hypothermic modulation of • anoxic brain injury in adult survivors of cardiac • arrest: A review of the literature and an algorithm for • emergency physicians. Canadian Journal of • Emergency Medicine. 7(1), 42-47. • Literature Review • 49-57% of post cardiac arrest patients were found to have positive neurological outcomes when treated with induced hypothermia therapy • Continues to be tested by the American Heart Association before it is recommended for standard practice