Mild therapeutic hypothermia.
Patients who survive cardiac arrest suffer widespread ischemia and edema leading to severe neurological impairment. Studies have been performed to show that brain injury or ischemia causes hyperthermia which extensively increases permanent neurological damage after cardiac arrest. Induction of therapeutic hypothermia has been shown to preserve neurologic function by an improvement of consciousness and alertness and a decrease in patient disability. The purpose of this study was to test a rapid, safe, and low cost cooling protocol by employing the simultaneous application of three cooling methods in post-cardiac arrest patients.
The sample population of the study included 65 patients that were admitted to the Medical Intensive Care Unit at Beth Israel Medical Center between April 2006 and April 2009 after suffering either an in-hospital or out-of-hospital cardiac arrest. The patients in the study were evaluated in the emergency room (ER) and hospital wards and met inclusion criteria for mild therapeutic hypothermia (MTH).
Following study protocol, therapeutic hypothermia for post-cardiac arrest patients included sedation and paralysis, rapid cold saline infusion, evaporative cooling, and gastric tube lavage. Participants' temperatures were monitored rectally throughout the treatment and MTH was discontinued when the temperature reached 34[degrees]C. The patients' temperatures were maintained between 32[degrees]C and 34[degrees]C for 24 hours and then blankets were placed on the patients for passive re-warming.
All patients reached the target temperature during MTH at an average cooling rate of 2.6[degrees]C per hour. The neurological outcomes were analyzed using Cerebral Performance Categories (CPC). Results showed that 27.7% of patients scored a CPC of 1 or 2, meaning patients were conscious and alert with slight or moderate disability after MTH. The results of this study demonstrated a rapid, safe, and low cost cooling technique which increases positive outcomes for patients that survived cardiac arrest. With supporting evidence-based research, it is crucial that all hospitals start implementing MTH protocol, to promote positive outcomes for cardiac arrest patients.
Castren, M.M. et.al. (2009). Scandinavian clinical practice guidelines for therapeutic hypothermia and post-resuscitation care after cardiac arrest. Acta Anaesthesiologica Scandinavica, 53(3), 280-288.
Kozik, T.M. (2007). Induced hypothermia for patients with cardiac arrest. Critical Care Nurse, 27(5), 36-43.
Jaimie deJager, Hartwick College, Oneonta, NY
Peggy Jenkins, Hartwick College, Oneonta, NY
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|Title Annotation:||WHAT'S NEW: IN THE HEALTHCARE LITERATURE|
|Author:||deJager, Jaimie; Jenkins, Peggy|
|Publication:||Journal of the New York State Nurses Association|
|Date:||Mar 22, 2012|
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