For more information, please refer to our Privacy Policy. (Cold skin surface temperatures can reduce the shivering threshold by up to 20%. Patients who are candidates for therapeutic hypothermia typically: Therapeutic hypothermia isn't appropriate for patients who are pregnant, patients who have do-not-resuscitate or do-not-intubate orders, patients with significant trauma or uncontrolled bleeding, patients who've recently had surgery, and patients with severe bradycardia, minimal premorbid cognitive status, or intracranial hemorrhage.8,9. arrive at the facility within 6 hours of cardiac arrest and are pulseless for less than 60 minutes. bag Learning by example, On Veterans Day, remember those living with mental health problems, Planning for high-risk maternity patients: A new approach. Areas for future research include larger sample sizes, prospective research design, and more studies exploring early nutrition intervention with targeted goals among this patient population.1-3,5-8,10.
10. Bernard S. Hypothermia after cardiac arrest: expanding the therapeutic scope. Early enteral nutrition, especially low volume feeds, is possible among this patient population. Protocol adherence was higher in the TTM-36 group.
Rapid and proper identification of candidates is key to starting therapeutic hypothermia promptly. At temperatures below 86° F (30° C), patients are more likely to develop life-threatening dysrhythmias that may be refractory to defibrillation or medications. John Dempsey Hospital, Department of Nursing, University of Connecticut Health Center. 6. Rewarming: During this phase, the patient is returned to normothermia. Maintenance: This is the longest phase of therapeutic hypothermia, lasting 12 to 24 hours, during which the patient is maintained at the target temperature.
View our awards for our success! Lee R, Asare K. Therapeutic hypothermia for out-of-hospital cardiac arrest. Therapeutic hypothermia after cardiac arrest in clinical practice: review and compilation of recent experiences. Therapeutic hypothermia is a type of treatment. 14. 1 However, implementation of therapeutic hypothermia protocols varies among institutions, and optimal management of adverse sequelae, such as shivering, has yet to be determined. All registration fields are required. Dumas F, Grimaldi D, Zuber B, et al. Therapeutic Hypothermia Protocols. We're passionate advocates of health and wellness. Kimberly Gottesman is a freelance registered dietitian with a strong background in clinical and food service management. Ventilator-associated pneumonia. Kammersgaard LP, Jorgensen HS, Rungby JA, et al. The patient's potassium and glucose levels will likely start to rebound during this phase, so expect possible decreases in blood glucose and ensure that all potassium-containing fluids have been stopped.7 Discontinue neuromuscular blockade once the patient's temperature is greater than 96.8° F (36° C), after which sedation can be weaned as well.9, Determining neurologic outcomes in patients who undergo therapeutic hypothermia after cardiac arrest is challenging. Purpose. 2009. For immediate assistance, contact Customer Service:
18. This study aims to compare protocol adherence, neurological outcome and adverse effects associated with a controlled hypothermia versus a controlled normothermia protocol in patients successfully resuscitated after cardiac arrest. 15. 8. Large volumes of intravascular fluids are contraindicated in patients with pulmonary edema or chronic renal failure.12, Specialized machines using a closed-loop central venous access device (CVAD) inserted into the femoral vein also can be used for invasive cooling. These guidelines will help prepare you to care for these patients during every phase of treatment. Excess extracellular potassium can lead to further cardiac instability and dysrhythmias, and excess intracellular sodium causes cellular edema. As the patient reaches the target temperature, the water is drained off the patient and the suit discarded. Fewer than 25% of EMS-treated out-of-hospital cardiac arrest victims have an initial rhythm of ventricular fibrillation (VF) or VT or have a shockable rhythm analyzed by an AED.2.
Risks of this system include unrecognized electrolyte shifts, intrinsic dangers of defibrillating a patient immersed in water, and potential for overcooling. Neurologic prognosis in cardiac arrest patients treated with therapeutic hypothermia. Part 9: post cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Care.