Hypothermia Manual


Published on

Manual of therapeutic hypothermia after cardiac arrest
Edward Omron MD, MPH, FCCP
Pulmonary, Critical Care Specialist
Morgan Hill, CA 95037

Published in: Health & Medicine
1 Comment
1 Like
  • All information contained on the this website is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider. We urge you to always seek the advice of your physician or medical professional with respect to your medical condition or questions. As a recipient of information from this website, you are not establishing a doctor/patient relationship with any physician. There is no replacement for personal medical treatment and advice from your personal physician. I make no warranties of any kind regarding, but not limited to, the accuracy, completeness, timeliness or reliability of this website’s content. Some information herein may cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, any product’s official prescribing information should be consulted before any such product is used. You agree to hold harmless , Edward Omron MD from all claims relating to this website and any website to which it is linked.
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Hypothermia Manual

  1. 1. Hypothermia Manual                           Dr. Edward Omron MD, MPH, FCCP
  2. 2. Upon reviewing this manual, the healthcare worker should be able to understand the goals of the hypothermia protocol as outlined under goals section. They should also be able to implement and practice the hypothermic intervention in the hospital to meet these goals. Introduction
  3. 3. This manual is designed to outline all aspects related to the hypothermic protocol including: 1) indications of its use 2) inclusion/exclusion criteria 3) procedures and policies related to the protocol 4) technical complications of using hypothermia 5) management and monitoring 6) evidence and support of its use 7) criteria met to receive privileges in the hospital
  4. 4. Healthcare workers should review the manual in its entirety and acquire the skills and comfort in its practice. Please call the Director of Critical Care for further questions.
  5. 5. Concept/Goal of Hypothermia Improving outcomes from sudden cardiac death is a healthcare dilemma and only 5-30% survive to discharge. Mild resuscitative therapeutic hypothermia is an intervention which may improve neurologic outcomes in survivors of cardiac arrest.
  6. 6. Mechanism of Hypothermia/How it Works <ul><li>Reduction in cerebral metabolism </li></ul><ul><li>Reduction in vascular permeability and cerebral edema </li></ul><ul><li>Reduction in immune response and inflammation </li></ul>
  7. 7. Steps of Technical Procedure Policy How to cool: Different cooling techniques are combined for optimal patient cooling. Induction cooling is accomplished initially with ice-chilled crystalloid infusion and ice packs followed by a cooling blanket system. Timing and Depth of Cooling: Cooling should be initiated after return of spontaneous circulation. The 2005 AHA ACLS guidelines recommend patients to 32-34 Celsius for 12-24 hours.
  8. 8. Cooling Monitoring: A bladder probe is recommended with the cooling protocol. Shivering which prevents achieving the target temperature is treated aggressively with Demerol and paralytics. Mechanically ventilated patients are deeply sedated. Steps of Technical Procedure Policy (continued) Re-warming: Therapeutic hypothermia is completed after 18 hours of cooling with subsequent rewarming to desired temperature.
  9. 9. Inclusion/Exclusion Criteria Inclusion Criteria: <ul><li>Adult Unconscious patients who have experienced a witnessed cardiac arrest of a presumed cardiac origin < 15 minutes from the patient’s collapse to the first attempt at resuscitation with no more than 60 minutes from collapse to restoration of spontaneous circulation. </li></ul><ul><li>OR </li></ul><ul><li>Unconscious adult patients who have experienced an acute ischemic stroke with Glascow Coma Score (GCS) < 8 and deemed appropriate for hypothermia or normothermia protocols by the attending physician, intensivist, or neurologist. </li></ul><ul><li>The patient must have endotrachial intubation with mechanical ventilation and a blood pressure that can be maintained at least 90 mm hg systolic either spontaneously or with fluids and pressors. </li></ul><ul><li>Thrombolytic therapy does not preclude the use of mild resuscitation hypothermia. </li></ul><ul><li>Percutaneous Coronary Intervention (PCI) does not preclude the use of mild resuscitative hypothermia. </li></ul>
  10. 10. Exclusion Criteria: <ul><li>age < 18 years old </li></ul><ul><li>pregnancy </li></ul><ul><li>coma before the arrest </li></ul><ul><li>response to verbal commands after return of spontaneous circulation </li></ul><ul><li>cardiogenic shock (systolic pressure < 90 mm Hg despite vasopressor tx) </li></ul><ul><li>clinical signs of pulmonary edema </li></ul><ul><li>rectal, esophageal, or bladder temperature < 30 degrees Celsius on initial measurement </li></ul><ul><li>patients with diagnosed terminal illnesses </li></ul><ul><li>unfavorable overall cerebral performance status before arrest </li></ul><ul><li>severe coagulopathy </li></ul><ul><li>another reason for comatose (drug overdose) </li></ul><ul><li>known hypersensitivity to any of the routinely used drugs in the protocol </li></ul>
  11. 11. Complications Complications of Cooling: <ul><li>induction hypothermia causes many physiological changes. Awareness of these changes is key to successful implementation. </li></ul><ul><li>hypovolemia (hypothermia induced dieresis) </li></ul><ul><li>coagulopathy (impaired coagulation cascade and thrombocytopenia </li></ul><ul><li>electrolyte disorders (hypothermia induced dieresis, K+, Mg++, Ca++) </li></ul><ul><li>insulin resistance </li></ul><ul><li>changes in drugs effects and metabolism (altered clearance of fentanyl, midazolam, and atracurium) </li></ul>
  12. 12. Complications of Re- warming: <ul><li>worsening cerebral edema </li></ul><ul><li>further changes in electrolyte abnormalities (especially hyperkalemia) </li></ul><ul><li>hyperthermia (induced fever) </li></ul>Complications (continued)
  13. 13. Polderman KH (2004) Application of Therapeutic Hypothermia in the Intensive Care Unit. Intensive Care Med 30:757-769 Polderman KH (2004) Application of Therapeutic Hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality (Part I). Intensive Care Med 30:556-575 Also see attached articles for further review/education Evidence/Support for Implementation of Hypothermia