Therapeutic hypothermia is recommended for comatose adults after witnessed outofhospital cardiac arrest, but data about this intervention in children are limited. Given the small size of these 2 studies, the differences in protocols, the inclusion of patients with vf only, and the absence of any subsequent well. Therapeutic hypothermia and temperature management vol 8, no 3. Clinical applications of induced hypothermia oxford academic. Is it feasible and safe to wake cardiac arrest patients receiving mild therapeutic hypothermia after 12 hours to enable early neuroprognostication. Studies may be in progress that permit therapeutic hypothermia on some infants who may not otherwise qualify for this therapy. Targeted temperature management ttm previously known as therapeutic hypothermia or protective hypothermia is an active treatment that tries to achieve and maintain a specific body temperature in a person for a specific duration of time in an effort to improve health outcomes during recovery after a period of stopped blood flow to the brain. Polderman department of intensive care, vu university medical center, po box 7057, 1007 mb amsterdam, the netherlands k. Post resuscitation care therapeutic hypothermia post resuscitation care is a new protocol for the maine 20 protocols. Therapeutic hypothermia does not appear to provide a survival or improved neurological benefit in both studies, no difference in survival, function at 12 months postarrest, blood product use, infection rates. Best practices 2014 deborah klein, rn, msn, acnsbc, ccrn, chfn, faha clinical nurse specialist coronary icu, heart failure icu, and cardiac short staypacucaru.
Therapeutic hypothermia th improves neurological recovery and reduces mortality after global ischemia, such as in patients with cardiac arrest, and in infants with moderate or severe hypoxicischemic encephalopathy 4. Therapeutic hypothermia, neonatal, hypoxic ischemic. The therapeutic effects of hypothermia were discussed as early as 400 bc when hippocrates mentions the use of snow and ice to reduce hemorrhage in patients 5. Therapeutic hypothermia for management of neonatal asphyxia. Heparin overview1 heparin is a glycosaminoglycan which inhibits the mechanism that induces the clotting of blood and the formation of stable fibrin. Patients who present to the emergency department ed or critical care unit ccu. Mild therapeutic hypothermia in patients resuscitated from outofhospital cardiac arrest. The hypothermia is maintained for 72 hours, and then the infant is gradually warmed to. Therapeutic hypothermia after cardiac arrest johns. Post cardiac arrest targeted temperature page 1 of 10. Therapeutic hypothermia also called targeted temperature management refers to deliberate reduction of the core body temperature, typically to a range of about 32 to 34 c 89. Hypothermic patients increase sensitivity to anticoagulation during hypothermia 2.
Dec 29, 2017 therapeutic hypothermia and targeted temperature management for traumatic brain injury. Therapeutic hypothermia is the process of cooling the body by reducing body temperature to 32. Order antixa level if known therapeutic enoxaparin administration prior to initiation of heparin drip. C, and the protocol is started within 6 hours after birth. Although the cooling protocol in mild ne was similar to that of infants with moderate or severe ne in terms of the target core temperature, there were a number of key differences. Villablanca, mohammed makkiya, evann einsenberg, david f. Spertus, md, mph to the editor dr chan and colleagues 1 evaluated the association between therapeutic hypothermia and survival to hospital discharge in patients with inhospital cardiac arrest and found lower survival among patients treated with therapeutic. Therapeutic hypothermia may cool the person too fast or to a temperature that is too low. A checklist was introduced to guide nurses in implementing the therapeutic hypothermia protocol during the different phases of the intervention initiation, maintenance, rewarming, and. S27984 august 2009 with 261 reads how we measure reads. This can cause the heart to beat slowly or out of rhythm. Hypoxicischemic encephalopathy hie therapeutic hypothermia admission eligibility. Therapeutic hypothermia in mild neonatal encephalopathy. The purpose of this protocol is to provide guidelines for the application of mild therapeutic hypothermia to comatose survivors of cardiac arrest in an attempt to improve neurologic outcomes.
This protocol outlines the approach for instituting immediate mild hypothermia core temperature of 3334 degrees celsius in patients presenting in coma following cardiac arrest outofhospital and inhospital. Therapeutic hypothermia for the management of intracranial hypertension in severe traumatic brain injury. The goal of therapy is to achieve and maintain mild therapeutic hypothermia for a 24 hour period with a target range of 3234c. The therapeutic hypothermia and early waking trial protocol.
An advisory statement by the advanced life support task force of the international liaison committee on resuscitation jerry p. The hypothermia is maintained for 72 hours, and then the infant is gradually warmed to normal body temperature 36. Anesthesia and analgesia protocol during therapeutic. Therapeutic hypothermia after cardiac arrest johns hopkins. Therapeutic hypothermia after cardiac arrest american nurse. To complete check list below prior to initiation of cooling inclusion criteria patient experienced a period of absence of pulses requiring chest compressions andor electric cardioversion followed by a. Once the heart starts beating again, healthcare providers use cooling devices to lower your body temperature for a short time.
There are a plethora of reasons for someone to sustain a brain injury. In this article, we will discuss brain injuries that result from a. Therapeutic hypothermia after outofhospital cardiac arrest. At mount sinai hospital in toronto, ontario, the goal of therapeutic hypothermia is to achieve a rectal temperature of 33. Noel watson, matt potter, grigoris karamasis, max damian, richard pottinger, gerald clesham, reto gamma, rajesh aggarwal, jeremy sayer.
There is little evidence to inform provision of enteral or parenteral nutrition to infants with hypoxic ischaemic encephalopathy hie during and soon after therapeutic hypothermia. The goal is to begin cooling as soon as absolutely possible, but no later than 6 hours after rosc. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services and structure, and clinical information. Mild therapeutic hypothermia after cardiac arrest protocol. Therapeutic hypothermia to be initiated per protocol as soon as possible after patient meets entry criteria and should be considered as proven to be therapeutic only if commenced in the first 6 hours of life. Therapeutic hypothermia hypothesized benefits include. Briceno, christia panagiota, mark menegus, mario garcia, daniel sims, harish ramakrishna. Therapeutic hypothermia th is recommended in postca patients who remain comatose after successful resuscitation. Therapeutic hypothermia after cardiac arrestreply paul s. No order, protocol or guideline can anticipate every clinical circumstance, nor are they meant to substitute clinical assessment and judgment. Pdf therapeutic hypothermia has been used for millennia, but in recent years was not in much clinical use due to an apparent high risk of. The goal of therapy is to achieve and maintain mild therapeutic hypothermia for a 24.
Md, mphfrom the levine cardiac intensive care unit, cardiovascular division, department of medicine, brigham and womens hospital and harvard medical school, boston, ma. Optimising nutrition during therapeutic hypothermia adc. Considerations for combining therapeutic hypothermia and. It is not a substitute for appropriate clinical evaluation and does not supersede clinical judgment. Therapeutic hypothermia after cardiac arrest protocol recommended protocol for cooling and rewarming. S therapeutic hypothermia and pharmacologic considerations genelle butz, pharmd director of pharmacy carolinaeast medical center august 6, 20. Although the latter remains in question, the pathogenesis of brain injury evolves over an extended interval of days. The therapeutic implications of hypothermia reentered the modern literature starting in the 194050s with the specific use of th in cardiac arrest patients 6 in 1959.
Adult heparin infusion protocol this protocol reflects current evidencebased clinical practice. Therapeutic hypothermia for management of neonatal. Demographics and other clinical data ere collected. Managing the airway and keeping the o2 sat greater or equal to 94% while at the same time being cognizant to prevent excessive ventilations and hyperoxia. Caring for patients treated with therapeutic hypothermia. Therapeutic hypothermia for outofhospital cardiac arrest. Patients who meet inclusion criteria post cardiac arrest should have their core body temperature reduced to. This includes if the infant is 6 hours old, or is t herapeutic hypothermia for comatose adults who have had an outofhospital cardiac arrest was recommended on the basis of results of clinical trials reported in 2002. The earliest recorded application of therapeutic hypothermia in medicine. Page 1 of 12 adult therapeutic hypothermia protocol. Cooling may cause the persons blood pressure to become too high or too low.
Therapeutic hypothermia protocol for cardiac arrest. Therapeutic hypothermia is a procedure used to cool a persons body to a temperature that is lower than normal. This method has since been adopted in a number of guidelines and protocols as the standard method of treatment in carefully selected patient groups. Hypothermia protocol external cooling device therakool sedation with midazolam and fentanyl. Therapeutic hypothermia after cardiac arrest jama jama. Oct 01, 2015 in summary, published results support the notion that timely resuscitation and implementation of a therapeutic hypothermia protocol therapeutic hypothermia in patients with aneurysmal subarachnoid hemorrhage, refractory intracranial hypertension, or cerebral vasospasm.
Hypothermia protocol and saving the brain after a cardiac. To the editor dr chan and colleagues 1 evaluated the association between therapeutic hypothermia and survival to hospital discharge in patients with inhospital cardiac arrest and found lower survival among patients treated with therapeutic hypothermia than among nonhypothermiatreated patients. Pdf therapeutic hypothermia after cardiac arrest researchgate. This pathway provides guidance for identifying neonates symptomatic at or near the time of birth from hypoxicischemic encephalopathy hie who may be eligible whole body cooling. Application of therapeutic hypothermia in the intensive care unit. If criteria are met, the patient is cooled using the induced hypothermia protocol for 24 hours to a goal temperature of 3234 c 8993 f. Therapeutic hypothermia after outofhospital cardiac. Hypothermia temperature 350 c following return of circulation. Its sometimes used for people who have a cardiac arrest. Eleven of 20 1120, 55% patients who were cooled as per protocol survived to hospital discharge, all having a good neurological outcome. Current literature does not support the routine utilization of hypothermia for conditions other than cardiac arrest callaway et al. Development and implementation of a therapeutic hypothermia. Ttm should not delay imaging studies, renal replacement therapy or reperfusion. The protocol encompasses several important treatment points.
In the initial randomized control trials demonstrating benefit with th, target temperature was achieved within 48 h postrosc. Therapeutic hypothermia and hospital factors influencing its use therhypothermia temp manag. Therapeutic hypothermia th is an effective treatment in models of experimental brain injury, including cardiac arrest, ischemic stroke, and traumatic brain injury tbi. Therapeutic hypothermia after cardiac arrest protocol 09. Therapeutic hypothermia code chill phases initiation or induction or cooling goal temp. Early screening and identification of candidates for neonatal. Therapeutic hypothermia with intracorporeal temperature. Probable perinatal asphyxia less than 8 hours of age moderate or severe encephalopathy no unstable coagulopathy or persistent pulmonary hypertension of the newborn pphn patient care therapeutic hypothermia protocol.
Therapeutic hypothermia has been used for millennia, but in recent years was not in much clinical use due to an apparent high risk of complications. Cardiac arrest happens when the heart suddenly stops beating. Following manufacturers recommended protocol for cooling and rewarming. Fluid loss from cooling can lead to dehydration or electrolyte body chemical levels that are out of balance. Therapeutic hypothermia is also called induced hypothermia. Therapeutic hypothermia protocol for cardiac arrest patient selection patients who present to the emergency department ed or critical care unit ccu after cardiac arrest in or out of hospital who have a return of spontaneous circulation rosc and have the following conditions should be considered for this protocol. Therapeutic hypothermia after cardiac arrest circulation. This void could explain the major variability in the protocols. Studies have shown that implementation of mild therapeutic hypothermia seems to. The hypothermia target is maintained for 24 hours starting at the time from initiation of therapy. Survivors of cardiac arrest who are treated with therapeutic hypothermia are very susceptible to complications with the. Utilization of a foley catheter with a temperature probe if available, otherwise a rectal temperature probe. Decreasing the temperature helps brain injuries after a cardiac arrest. Post cardiac arrest targeted temperature page 2 of 10 management ttm disclaimer.
Therapeutic hypothermia american heart association. There is a growing body of evidence that therapeutic hypothermia th in patients who are comatose after cardiac arrest improves neurologic outcomes. Application of therapeutic hypothermia in the intensive care unit opportunities and pitfalls of a promising treatment modality kees h. The procedure is done after a cardiac arrest when the heart stops that happens outside of a healthcare setting. A 2014 uk survey found that 79% 33 of 42 of responding neonatal units routinely withheld enteral nutrition during cooling.
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