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Prehospital induced hypothermia post cardiac arrest jun 2010[1]

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Robert Cole
Robert Cole
Health & MedicineBusiness
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Induced Hypothermia in Post-Cardiac Arrest Patients Brandon Wilding, MD FACEP Idaho Emergency Physicians Saint Alphonsus Regional Medical Center Boise, Idaho
Historical Trivia, Name the Disease: ,[object Object]
Name the Disease (Cont.): ,[object Object],[object Object],[object Object],[object Object]
Name the Disease(Cont.): ,[object Object],[object Object],[object Object],[object Object]
Name the Disease (Cont.): ,[object Object],[object Object],[object Object],[object Object]
Answer: Scurvy ,[object Object],[object Object],[object Object],[object Object]
Scurvy Timeline ,[object Object],[object Object],[object Object],[object Object]
Fascinating, but is there any relevance? ,[object Object],[object Object]
Induced Hypothermia Post Cardiac Arrest with ROSC ,[object Object],[object Object],[object Object],[object Object]
What does “improved outcomes” mean? ,[object Object],[object Object]
Historical Perspective ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Australian Study* ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Australian Study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
European Study* ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
European Study* ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
European Study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mild Therapeutic Hypothermia to Improve Neurologic Outcome after Cardiac Arrest
Mild Therapeutic Hypothermia to Improve Neurologic Outcome after Cardiac Arrest ,[object Object]
Holzer, et al 1 . ,[object Object],[object Object],[object Object],[object Object],[object Object]
ILCOR Advisory Statement ,[object Object],[object Object],[object Object]
Why does it work? Theoretical Basis: ,[object Object],[object Object],[object Object],[object Object]
Theoretical Basis for Hypothermia ,[object Object],[object Object],[object Object],[object Object]
Why does it work? Theoretical Basis: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ischemic Neuron
Why does it work? Theoretical Basis: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why does it work? Theoretical Basis: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why does it work? Theoretical Basis: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Are there benefits to delayed cooling? ,[object Object],[object Object],[object Object]
Risks of Hypothermia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Risks of Hypothermia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Risks of Hypothermia ,[object Object],[object Object],[object Object],[object Object],[object Object]
Potential Side Effects & Frequency High Probability Coagulopathy Hypovolemia (increased diuresis) Electrolyte disorders Insulin resistance,  secretion Low Probability Manifest bleeding Airway infections (with prolonged hypothermia) Wound infections (vasoconstriction & transient immune supp.) Myocardial ischemia Rare Manifest pancreatitis Intracerebral bleeding
Other Risks/ Unknowns ,[object Object],[object Object],[object Object],[object Object]
Induced Hypothermia is Underutilized ,[object Object],[object Object],[object Object]
Induced Hypothermia is Underutilized ,[object Object]
New ACLS Guidelines ,[object Object],[object Object]
Underutilization was predictable ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Delay in Implementation was predictable ,[object Object],[object Object]
Proposed ACLS Algorithm ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Specifics ,[object Object],[object Object],[object Object],[object Object],[object Object]
Details, details, details. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cooling helmet ,[object Object],[object Object]
Cooling Blanket Device ,[object Object],[object Object]
Cooling catheter ,[object Object]
Chilled IVF Protocols ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chilled IVF Protocols ,[object Object],[object Object],[object Object],[object Object],[object Object]
Immediate Prehospital Hypothermia feasible and safe ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pre Hospital Induced Hypothermia Rarely Used 1 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Barriers to Pre Hospital Induced Hypothermia 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prehospital Initiation of Hypothermia Feasible & Safe 1 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Prehospital Initiation of Hypothermia Feasible & Safe 1 ,[object Object],[object Object],[object Object],[object Object]
Proposed Hypothermia Protocol
Duration of Pulselessness Predicts Outcome ,[object Object],[object Object],[object Object],[object Object],[object Object]
What about STEMI arrests? ,[object Object],[object Object],[object Object]
Case Report: Cocaine induced Cardiac Arrest 1 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case Report: Cocaine induced Cardiac Arrest ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case Report: Cocaine induced Cardiac Arrest ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case Report: Cocaine induced Cardiac Arrest ,[object Object],[object Object],[object Object],[object Object]
Case Report: Cocaine induced Cardiac Arrest
Case Report: Cocaine induced Cardiac Arrest
Case Report: Cocaine induced Cardiac Arrest
Case Report: Cocaine induced Cardiac Arrest ,[object Object],[object Object],[object Object],[object Object]
St Alphonsus Experience ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusion ,[object Object],[object Object],[object Object],[object Object],[object Object]
Other Indications for Therapeutic Hypothermia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ACP Induced Hypothermia Protocol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ACP Induced Hypothermia Protocol ,[object Object],[object Object],[object Object],[object Object],[object Object]
ACP Induced Hypothermia Protocol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ACP Induced Hypothermia Protocol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ACP Induced Hypothermia Protocol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
2000 > or = 65 1800 60 1650 55 1500 50 1350 45 1200 40 1050 35 900 30 Volume Max (mL) WEIGHT (kg) 0.9 Normal Saline at near freezing ,[object Object],[object Object]
90-100 65-80 140 90-100 70-85 130 90-100 75-90 120 90 80 110 Map Diastolic Systolic ,[object Object],[object Object],[object Object]
ACP Induced Hypothermia Protocol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ACP Induced Hypothermia Protocol ,[object Object],[object Object],[object Object]
?????Where does it all go?????
The Thomas EMS “Chillcore Case”
The Thomas EMS “Chillcore Case” ,[object Object],[object Object]
The Thomas EMS “Chillcore Case” ,[object Object],[object Object]
The Thomas EMS “Chillcore Case” ,[object Object],[object Object]
BATTERY LEVEL & MAINTENANCE ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Thomas EMS “Chillcore Case” ,[object Object]
The Thomas EMS “Chillcore Case” ,[object Object],[object Object]
Conclusion #2 Eat yer oranges or be a scurvy dog.
Questions?

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Prehospital induced hypothermia post cardiac arrest jun 2010[1]

  • 1. Induced Hypothermia in Post-Cardiac Arrest Patients Brandon Wilding, MD FACEP Idaho Emergency Physicians Saint Alphonsus Regional Medical Center Boise, Idaho
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  • 17. Mild Therapeutic Hypothermia to Improve Neurologic Outcome after Cardiac Arrest
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  • 32. Potential Side Effects & Frequency High Probability Coagulopathy Hypovolemia (increased diuresis) Electrolyte disorders Insulin resistance,  secretion Low Probability Manifest bleeding Airway infections (with prolonged hypothermia) Wound infections (vasoconstriction & transient immune supp.) Myocardial ischemia Rare Manifest pancreatitis Intracerebral bleeding
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  • 59. Case Report: Cocaine induced Cardiac Arrest
  • 60. Case Report: Cocaine induced Cardiac Arrest
  • 61. Case Report: Cocaine induced Cardiac Arrest
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  • 75. ?????Where does it all go?????
  • 76. The Thomas EMS “Chillcore Case”
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  • 82.
  • 83. Conclusion #2 Eat yer oranges or be a scurvy dog.