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Therapeutic Hypothermia

Intro: The induction of Mild Therapeutic Hypothermia has been proven to improve mortality and neurological outcomes in survivors of cardiac arrest. This effect is achieved by decreasing cerebral oxygen consumption, suppression of free radical reactions, a reduction of intracellular acidosis and inhibition of excitatory neurotransmitters. The Critical Care community at the Mount Sinai Hospital and Mount Sinai school of Medicine are dedicated to providing this therapy to our patients.

Project Hypothermia: Therapeutic Hypothermia has been provided to appropriate survivors of cardiac arrest at Mount Sinai since April 2008. Mount Sinai is now part of the GNYHA/FDNY/REMSCO city wide initiative to provide this therapy to survivors of cardiac arrest. As part of this effort we are collecting QA data as part of our agreement to collaborate with NY Project Hypothermia. In addition to the standard cooling procedure for our patients you will be asked to complete a very brief form. For your convenience the full protocol, ED worksheet, shivering protocol and QA form are provided here:

Resources:

Lecture: available Navigating the cool waters of hypothermia.

Video: Hypothermia – Getting it Done at emcrit.org

REFERENCES

2002 Studies – the big ones:
Hypothermia after Cardiac Arrest Study Group, (2002). Mild Therapeutic Hypothermia to Improve Neurologic Outcome After Cardiac Arrest. New England Journal of Medicine, 346 (8), 549-556.
Bernard, S., Gray, T., Buise, M., Jones, B., Silvester, M., Gutteridge, M., Smith, K. (2002). Treatment of Comatose Survivors of Out-Of-Hospital Arrest with Induced Hypothermia. New England Journal of Medicine, 346 (8), 557-563.

2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005;112[Suppl I]:IV-84-IV-88.
Burns, S. (2001). Revisiting Hypothermia; A Critical Concept. Critical Care Nurse, 21 (2), 83-86.
Ginsberg MD. Hypothermic Neuroprotection in Cerebral Ischemia. In Primer on Cerebrovascular Diseases. 1997:272-275.
Ginsberg MD, Sternau LL, Globus MY, Dietrich WD, Busto R. Therapeutic modulation of brain temperature: relevance to ischemic brain injury. Cerebrovasc Brain Metab Rev 1992; 4:189-22.
Holzer M, Bernard SA, Hachimi-Idrissi S, Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis. Crit Care Med. 2005 Jun;33(6):1449-52.
Nolan J, Morley P, Vanden Hoek T, Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advanced Life Support Task Force of the International Liason Committee on Resuscitation (ILCOR). Resuscitation 2003;57:231-235.
Mayer SA, Sessler DI. Therapeutic Hypothermia. New Tyork: Marcel-Dekker, 2005.
Polderman KH. Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality – Part 2: Practical aspects and side effects. Intensive Care Med 2004; 30: 757-769.

Cooling with IV Saline
Bernard S, Buist M, Monteiro O, Induced Hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation 2003;56:9-13.
Kim F, Olsufka M, Longstreth WT, Pilot Randomized Clinical Trial of Prehospital Induction of Mild Hypothermia in Out-of-Hospital Cardiac Arrest Patients with a Rapid Infusion of 4 °C Normal Saline. Circulation 2007;115;3064-3070.
Polderman K, Rijnsburger E, Peerdeman S, Induction of hypothermia in Patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid. Crit Care Med 2005;33:2744-2751.

Shivering Management
Alfonsi P, Sessler D, Dumanoir B. The effects of meperidine and sufentanil on the shivering threshold in postoperative patients. Anesthesiology 1998;89:43-8.
Doufas AG., Lin CM., Suleman MI., Dexmedetomidine and meperidine additively reduce the shivering threshold in humans. Stroke 2 003 May;34(5):1218-23.
Mokhtarani M, Maghoub A, Morioka N. Buspirone and meperdine synergistically reduce the shivering threshold. Anesth. Analg. 2001;93:1223-9.
AHA 2005 Guidelines

Physiology of Hypothermia

Polderman KH.  Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med. 2009;37:7:S185=S294.

Cooling Device Manufacturers:
Alsius Corporation (Irvine, CA; maker of endovascular cooling catheter systems
Innercool Medical (San Diego, CA; maker of endovascular cooling catheter system)
EMCOOLS (Austria; maker of external cooling blanket)
Adroit Medical(Loudon, TN; maker of internal and external cooling devices)
MTRE Advanced Technologies – link from Adroit Medical
Life Recovery Systems (Alexandria, LA; maker of external cooling system)
Medivance, Inc. (Louisville, CO; maker of external cooling system)
Radiant Medical (Redwood, CA; maker of endovascular cooling catheter system)

Hypothermia Research:
The Hypothermia Network
Center for Resuscitation Science (University of Pennsylvania)
Emergency Resuscitation Center (University of Chicago)
European Resuscitation Council
Safar Center for Resuscitation Research (University of Pittsburgh)
The Hypothermia After Cardiac Arrest Registry (European Registry Site)
Food and Drug Administration (FDA) consideration of hypothermia

Written by phil

July 6th, 2009 at 7:03 pm

Posted in Hypothermia

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