Introduction
Hypothermia protocol for the post cardiac arrest patient has been an evidence based practice of this therapy for about a decade now. This intervention, often used in the critical care setting, is now expanding to primary emergency responders as well. This paper will present some of the notable research that has been done on therapeutic hypothermia, and current use of this intervention.
Control studies, animal studies, and case studies have been published related to these medical interventions. Unfortunately, there are still many healthcare providers not using this intervention. Dainty, Scales, Brooks, Needham, Dorian, Ferguson et al. (2011) study states, “observational research shows that therapeutic hypothermia is delivered inconsistently, incompletely, and often with delay.” In addition a survey that same study found, of Canada and U.S. physicians who replied, only 26% used hypothermia in resuscitated patients (p. 2).
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Hypothermia protocol is not universally used at all hospitals, but the facilities that do use it have similar methods. Based on two studies done in 2002 the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR) suggested that “unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours when the initial rhythm was ventricular fibrillation (VF)” (Writing Group, Nolan, Morley, Vanden, Hickey, Members of the Advanced Life Support Task Force et al., 2003, p. 118). They also stated it could be beneficial for other rhythms as well. This was the first big step in using hypothermia in the critical care setting. The current protocol still uses that recommendation.
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...rch in Cardiology, 106(5), 697-708.
Hammer, L., Vitrat, F., Savary, D., Debaty, G., Santre, C., Durand, M., et al. (2009). Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest. American Journal of Emergency Medicine, 27(5), 570-573.
Torgersen, J., Strand, K., Bjelland, T. W., Klepstad, P., Kvale, R., Soreide, E., et al. (2010). Cognitive dysfunction and health-related quality of life after a cardiac arrest and therapeutic hypothermia. Acta Anaesthesiologica Scandinavica, 54(6), 721-728.
Wall, R., J. (2011). Use of therapeutic hypothermia after cardiac arrest. Critical Care Alert, 19(3), 17-20.
Writing Group, Nolan, J. P., Morley, P. T., Vanden Hoek, T. L., Hickey, R. W., Members of the Advanced Life Support Task Force, et al. (2003). Therapeutic hypothermia after cardiac arrest. Circulation, 108(1), 118-121.
This essay will discuss the risks for patients during the preoperative, intraoperative and postoperative stages of the perioperative journey and how both patients and healthcare professionals involved in the perioperative stages can work together to prevent perioperative hypothermia.
Inadvertent perioperative hypothermia is a common anesthesia-related complication with reported prevalence ranging from 50% to 90%.(ref 3,4 of 4) The clinical consequences of perioperative hypothermia include tripling the risk of morbid myocardial outcomes and surgical wound infections, increased blood loss and transfusion requirements, and prolonged recovery and hospitalization.(ref 5)
Targeted Temperature Management at 33 degree versus 36 degree after Cardiac Arrest (Neilsen et al)
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Khan, M. Faisal M.D. No Date. New Hypothermia Technique Protects Heart Attack Patients. Memorial Hermann. Retrieved from www.fbindependent.com/new-hypothermia-technique-protects-heart-attack-patients-p3615-91.htm. April 18, 2011.
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Kupchik and Bridges make a case that a need exists for an improvement in nursing care regarding the in-hospital cardiac arrest by believing there can be an improvement in the survival rate. “The percentage of patients who survive to discharge after in-hospital cardiac arrest us a dismal 18%.” (Kupchik & Bridges, 2015, p. 51) Therefore if the AHA’s five critical areas are used on a cardiac arresting patient, there could be a better and longer chance of survival. Once a person goes into cardiac arrest the first move is CPR; the AHA thinks we are compressing too fast, around 120 compressions per minute. The problem with this is it doesn’t “allow for full recoil of the chest and can lead to increased intrathoracic chest pressure, [overall] decreasing
It is very important to discuss resuscitation efforts with patients, once they are admitted to the hospital. Regardless of the patient’s situation, they have the right to choose the care provided to them. Cardiopulmonary resuscitation, “is an emergency procedure performed on individuals who experience a cardiac arrest” (p.420). There are numerous conditions or health problems that can bring about the need for cardiopulmonary resuscitation. The need for cardiopulmonary resuscitation may come about suddenly or gradually. Cardiopulmonary resuscitation can bring about legal ethical issues if not handled correctly. It is important to discuss cardiopulmonary resuscitation status with patients because it can unwanted harm to the patient, legal
Clinical question: What is the most effective and most practical way for cooling the patient?
Recent studies have shown patients suffering from cardiac arrest are treated with mild therapeutic hypothermia is now recognized as standard therapy in patients resuscitated from out-of-hospital cardiac arrest (OHCA) leading to unexpected death 1 in 1500 adults each year in this hi tech world (Zheng et al 2001). Therapeutic hypothermia (TH) may increase survival and reduce the amount of neurologic damage after cardiac arrest. According to the recent guidelines, comatose survivors of out-of-hospital ventricular fibrillation cardiac arrest should be cooled with internal or external cooling techniques to a target temperature of 32 °C to 34 °C (patients with in-hospital cardiac arrest or other primary rhythms may also be cooled. This target temperature should be maintained for 12 to 24 hours, and after this cooling period the patients should be rewarmed at a rate of 0.25 °C to 0.5 °C hour to normothermia. Significant survival and functional benefit impelling increased acceptance of use of TH.
Tamborini, Ron ; Eastin, Matthew S. ; Skalski, Paul ; Lachlan, Kenneth ; Fediuk, Thomas A. ;
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