Therapeutic hypothermia after cardiac arrest is an increasingly used strategy to improve outcomes after myocardial infarction. Most medical centers have developed protocols to be used by the emergency medicine, ICU, and nursing staffs. One representative protocol that is similar to the one used at the University of Chicago Medical Center is outlined below.
Eligibility for therapeutic hypothermia
1. status post cardiac arrest
2. return of spontaneous circulation within previous 6 hours
3. presence of coma (patient does not follow commands or open eyes to pain)
4. check pregnancy status in women < 50 and if positive contact Obgyn
1. refractory shock (SBP , 90 mmHG on pressors and fluids)
2. refractory ventricular arrhythmia such as vfib, vtach or torsades
3. drug overdose
9. head trauma
10. assymetrical neurological clinical exam
11. significant pre-existing neurological impairment
13. liver failure
14. severe thrombocytopenia (20K)
15. pre-arrest life expectancy < 6 months
Baseline Nursing Assessment
1. tympanic temperature
2. best motor response (purposeful, localizes pain, withdraws to pain, no response)
3. best eye opening response (spontaneous, opens to speech, pain, none)
4. presence of spontaneous respiratory effort (none, irregular, gasping)
5. pupil diameter and response to light
1. CBC, platelet count
2. basic metabolic panel, mag, phos, calcium
3. LFTs, lipase
5. CPK, MB, troponin
Hypothermia Induction Phase
Goal is to decrease patient temperature to < 34 degrees within 1-2 hours optimally of resuscitation. Generally 1 L of 4 degrees C saline cools 70 Kg patient 1.0-1.2 degrees C.
1. Administer chilled .9% normal saline intravenous bolus of 30ml/Kg up to maximum of 3L via pressure bag infuser. Aim is to infuse 1 L over 20 minutes. Stop infusion if SaO2 < 90%
2. Suction stomach contents via gastric tube
3. Rapidly bolus via NGT 250-500 ml bolus of 4 C .9% saline or iced tap water.
4. After 5 minutes if 250 ml or 10 minutes if 500 ml was infused, suction fluid from the stomach via NGT
5. Repeat gastric administration of iced fluid until 30ml/KG has been administered and then removed.
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