Therapeutic Hypothermia

[Coastie]

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Thoughts? Experiences? Primarily asking after someone is "found down", with cardiac arrest.

 

[Bertelman]

We do a fair number of these. Walk through the ICU any given day, there's someone cooling. Results vary. I've seen them wake up during the cooling phase, I've also seen them never wake up. It most likely helps a few cases. I'd guess we'll see more of this, with more indications in the future.

 

[Magnus67]

A week or two of this year on ICU and CICU i will fondly remember as my "artic sun" fellowships. We do alot of these at my program. I have found that the data presented in marino's icu book for cpr time and satifactory neurological outcome holds true even with our hypothermia protocol. CPR within 6 minutes of event for over 30 minutes = no grey/white differentiation on CT scan 48 hours later and me withdrawing support at 72 hrs. I was pretty pecemistic about the neuroprotective effect until i started having a couple 20-25 minute downtime people make full recoveries. I dont like the BIS, but we use it during the cooling process and at least when it reads zero for 24 hours during cooling and paralysis, the patients have eventually been declared brain dead. I have only done about 12 or so of these cases, but I think it has a place in patients that have had high quality cpr with reasonable downtimes. I still have yet to figure out why we code people for over an hour, but its seems to happen a lot in our ED. I'm all for giving people hope and a chance to live, but I question the victory of getting the heart restarted when a person needs two pressors, a vent, and has had an anoxic brain for 45 minutes, but that is a whole different topic.🙁