therapeutic hypothermia robert dortman, steven lucynski, & lauren wynder

Therapeutic Hypothermia

Robert Dortman, Steven Lucynski, & Lauren Wynder

Objectives

After this presentation, the audience will be able to...

1. Identify indications for Therapeutic Hypothermia (TH)

2. Discuss contraindications for TH

3. Identify the complications & risks of TH

4. Address the nursing management of TH

Indications

Cardiac arrest*StrokeNeonatal encephalopathySpinal cord injury

Significance

Improves neurological outcomes in post-cardiac arrest by decreasing cellular metabolism and oxygen demand

Collaborative life-saving intervention

Nursing research

Aim: to determine adherence and barriers to Therapeutic Hypothermia for out of hospital cardiac arrest patients

Type of study: Retrospective chart audit over 12 months

Results:

33 patients met inclusion criteria

Only 4 at the goal temperature of 32.5-33.5 C in target time of 2 hrs

17 not cooled at all

Length of time prior to cooling varied = <1 hr (n=15)- >3 hr (n=5)

9 cooled for recommended time; 18 cooled to target temperature; 9/18 consistent with guidelines

Implications: Poor education on management --->regular education sessions. Ready access to cooling agents

Types

Invasive: cooling catheters, cooled blood and saline fluids

Non-invasive: cooling blankets, cooling caps, ice packs, Arctic Sun

Phases:

1. Cooling

2. Maintenance

3. Rewarming

When to initiate therapy

Within 12 hours of the return of spontaneous circulation post

cardiac arrest

Patient prep

Begin sedation after decision for TTM has been made (goal: RASS -5)

Arterial line and CVP line inserted

Labs drawn

Place temp probe x2 no oral/axillary

Skin assessment (esp posterior)

Lowest room thermostat temperature

Arctic sun

Non-invasive TTM system

Pads are placed around patient’s legs and torso

Pads circulate water that can cool and rewarm patients

Can control body temperature within 0.2°C

Inclusion criteria

ET intubated & ventilated

Arrived at facility within 6 hours & pulseless for less than 1 hour

Resuscitated from cardiac arrest with an initial rhythm of VF, pulseless VT, pulseless electrical activity, or asystole

GCS score <8

Hemodynamically stable (with or without vasopressors)

Exclusion criteria

◦Pregnant women

◦DNR and/or DNI

◦Sepsis

◦Significant trauma

◦Uncontrolled bleeding

◦Recent surgery

◦Severe bradycardia

◦Intracranial hemorrhage

Complications & Management

◦Prolonged PT & PTT; clotting factors depressed: Monitor Labs and obtain

blood cultures

◦Skin breakdown: Assess skin

◦Shivering: NMBA, tylenol/demerol and/or bair hugger

◦Cardiac dysrhythmias r/t K + Ca: IV fluid replacement therapy

◦Changes renal blood flow and reduces sodium absorption: Strict intake and

output monitoring

Complications & Management

Changes renal blood flow and reduces sodium absorption: Strict intake and

output monitoring

Hyperglycemia: Glucose checks

Infection: Administer broad spectrum antibiotics, maintain aseptic technique

10% in study showed critical hypotension: Administer vasopressors PRN

Conclusion

Objectives Met?

Identified indications for TTM

Discussed contraindications for TTM

Identified complications and risks TTM

Addressed nursing management of TTM

Questions?

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Heard, K. J., Peberdy, M. A., Sayre, M. R., Sanders, A., Geocadin, R. G., Dixon, S. R., ... & O’Neil, B. J. (2010). A

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