Therapeutic hypothermia, or induced hypothermia, involves deliberately cooling cardiac arrest patients to between 32-34°C for 12-24 hours after return of spontaneous circulation (ROSC) to reduce reperfusion injury to organs like the brain, heart, liver and kidneys from hypoperfusion and ischemia during the cardiac arrest. It aims to improve outcomes by reducing the effects of post-cardiac arrest syndrome, which involves a complex pathophysiological cascade following ischemia. Current research shows benefits of inducing therapeutic hypothermia before or during the cardiac arrest event. Key aspects of care involve induction of hypothermia within 6 hours, preferably 2 hours, of ROSC, maintenance of target temperature for 12-24 hours,

1. Post Resuscitation CareBy Kane Guthrie

2. ObjectivesCase studyUnderstand post-resuscitation careLook at therapeutic hypothermia

3. Cardiac Arrest the Stat’sGenerally 6-7% survival rate (worldwide)0nly 3-4% leave hospital with RONFEarly Defib/compressions make the differencePost resuscitation care is the answer to improving mortality and morbidity with ROSC.

4. The New Guidelines!!

5. Case Study68 male walking home from pubCollapse > Cardiac Arrest >Bystander CPRSJA arrive 13mins post arrestIn VF, Successful ROSC post x3 defibsArrives in T2 20 mins later with no RONFWhat should we do now?

6. Post Resuscitation CareWhat is it?Where does it start?Why is it done poorly?What is Post Cardiac Arrest Syndrome?What is Therapeutic Hypothermia?

7. Post Cardiac Arrest Syndrome!!Thought to be RT production of free radicalsPathophysiology is very complex = BORINGHypoperfusion & Ischaemia cause cascade of events

8. The Big 4 in Postcardiac Arrest Syndrome

9. Therapeutic Hypothermia‘Induced hypothermia” is were pt is deliberately cooled between 32-33.9°CIt aims to reduce hypoperfusion (& reperfusion) injury post arrest.Focuses mainly on brain (neuroprotection), but offers protection to heart, liver, kidneys.Current research shows benefit of inducing TH before or during event.

10. Therapeutic HypothermiaTherapeutic hypothermia is the first treatment that has proven effective for post-resuscitation reperfusion injury.NNT 1:6 vs 1:42 for aspirin in STEMI

11. Who’s up for it?Cardiac arrest with ROSC Persistent significant altered level of consciousness<12 hours from time of ROSCPatients >18 years

12. Who’s on the Fence?Relative:Persistent hypotension (MAP <60, SBP<90) despite use of inotropes and vasoconstrictors Note:Hypothermia will cause vasoconstrictionAnd help ∧BP

13. Who’s not?Advanced directive stipulating DNR (absolute)Traumatic arrestActive bleeding (including intracranial)Pregnancy, recent major surgery, severe sepsis

14. What are the 3 Phase’s of TH?InductionAim reduce core temp 32-34°C (within 6 hours, preferably 2 hours)MaintenanceMaintain core body temp for 12-24Rewarming Either controlled or passive rewarming to normothermia 37°C0.2-0.5°C per hour –over 8-12 hours

15. ED Management

16. Cooling MethodsCold saline (during arrest & post arrest)ICE Packs (axilla, groin) Keep pt dry

17. Monitor skin integrityMachine (Vest, Artic Ice)

18. What you needPatient airway secured (sedated & paralyzed)ICE and bagsCold saline12 lead ECGArtlineNGTIDCRectal probe?CVC

19. ED ManagementPrepare patient for T/F to ICU, Cath LabMonitoring the bloods

20. Remember the basicsPressure area careVTE prophylaxisStress ulcer prophylaxisLung protective ventilationNutritionSocial support (family)

21. ComplicationsTachycardia > bradycardiaHypertensionDiuresis (hypovolaemia)Shivering (increases temp)Arrhythmia'sIncrease bleedingSpiking temp’s look for signs of infection

22. Questions

23. Thank-You