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Therapeutic Hypothermia

Therapeutic Hypothermia. Kristi Valdez RN,BSN,CCRN NUR 5200 Introduction to Graduate Nursing. Question. Does the effect of therapeutic hypothermia improve mortality and neurological outcomes in cardiac arrest patients compared to normothermia?. Background.

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Therapeutic Hypothermia

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  1. Therapeutic Hypothermia Kristi Valdez RN,BSN,CCRN NUR 5200 Introduction to Graduate Nursing

  2. Question Does the effect of therapeutic hypothermia improve mortality and neurological outcomes in cardiac arrest patients compared to normothermia?

  3. Background 300,000 deaths occur annually from cardiac arrest Mortality rate in out of hospital cardiac arrest is more than 90% Of the patients that reach the hospital after cardiac arrest, only 11-48% will have favorable neurological outcome (Laird,2009)

  4. Effects of Cardiac Arrest When cerebral perfusion and oxygen delivery stop during cardiac arrest, the oxygen stores are depleted within 20 seconds. As a result electrolyte imbalances, cellular edema, and cell death occur. After ROSC occur, reperfusion injury occurs. This process can last 24-48 hrs. (McKean, 2009, pg. 344)

  5. Definition of Therapeutic Hypothermia Controlled Induced hypothermia

  6. Effects of Therapeutic Hypothermia Decreasing the cerebral metabolic rate decreases cerebral oxygen consumption Reduces disruptions in the blood-brain barrier and prevents premature cell death AHA recommends patients be cooled to 32-34 degrees Celsius for 12-24 hours. The patient is then rewarmed slowly at 0.5 degrees Celsius per hour (McKean, 2009,pg. 345,352)

  7. Patient Selection Inclusion criteria: • 18 yrs. and older • GCS < 8 after ROSC • Less than 6 hours from ROSC and start of cooling • SBP>90 mm/hg • Intubated with Mechanical ventilation Exclusion criteria: • Preexisting bleeding or coagulopathy • Trauma • Recent major surgery • Known systemic infection/sepsis

  8. Types of hypothermia treatments Invasive hypothermia Iced intravenous fluids Intravascular catheters Non-invasive hypothermia • Ice packs • Fans • Cooling blankets

  9. Current Evidence

  10. Current Evidence

  11. Conclusion After reviewing current evidence, therapeutic hypothermia does improve neurological and mortality outcomes compared to normalthermia.

  12. References Calver, P., Braungardt, T., Kupchik, N., Cutler, C., & Jensen, A. (2005). The big chill: improving the odds after cardiac arrest. Rn, 68(5), Laird, P. (2009). Induced hypothermia for neuroprotection following cardiac arrest: a review of the literature. Internet Journal Of Advanced Nursing Practice, 10(2), 4. McKean, S. (2009). Induced Moderate Hypothermia After Cardiac Arrest. AACN Advanced Critical Care, 20, 343-355. Retrieved from www.aacn.org Collins, T., & Samworth, P. (2008). Therapeutic hypothermia following cardiac arrest: a review of the evidence. Nursing In Critical Care, 13(3), 144-151. Zeitzer, M. (2005). Inducing hypothermia to decrease neurological deficit: literature review. Journal Of Advanced Nursing, 52(2), 189-199. doi:10.1111/j.1365-2648.2005.03574.x Clumpner, M., & Mobley, J. (2008). Raising the dead: prehospital hypothermia for cardiac arrest victims may improve neurological outcome and survival to discharge. EMS Magazine, 37(9), 52-60.

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