Therapeutic hypothermia and temperature management
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Ther Hypothermia Temp Manag · Jan 2011
Use of therapeutic hypothermia in postcardiac arrest patients by emergency departments.
Since 2003, resuscitation guidelines have recommended the use of induced hypothermia as a therapy for patients who achieve return of spontaneous circulation after cardiac arrest from ventricular fibrillation. The aim of this study was to survey emergency physicians across the United States on their use of therapeutic hypothermia (TH) after cardiac arrest. An 18-question survey was e-mailed to a sample of emergency physicians. ⋯ A shivering protocol is used by 76% of respondents, and as a first line medication, 46% use benzodiazepines. For those who do not use TH or do not have a protocol in place, the reasons cited include "too expensive," "too difficult to implement," and "not enough science to warrant it." In this sample of practicing emergency physicians, TH after cardiac arrest is not being used as described in the original literature. Although awareness and implementation of TH have increased, there appears to be a wide variation in the application of this therapy.
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Ther Hypothermia Temp Manag · Jan 2011
Prehospital use of therapeutic hypothermia after resuscitation from cardiac arrest.
The use of therapeutic hypothermia (TH) in the care of patients after resuscitation from sudden cardiac arrest (SCA) has been shown to improve both survival and neurologic outcomes in randomized, controlled trials and a growing number of cohort studies with historical controls. The robust nature of the data supporting postarrest TH is reflected in the wide variety of clinical investigations that have confirmed outcome benefits of similar magnitude. A number of important questions remain surrounding the implementation of postarrest TH, including the timing of cooling induction and how rapidly providers need to initiate cooling therapy. ⋯ In this paradigm, emergency medical service (EMS) personnel are able to start cooling therapies immediately after resuscitation, which can then be continued during transport. Newer technologies may provide other opportunities for rapid cooling in the field; however, the risks and benefits of prehospital cooling remain poorly understood. This review will describe the growing literature and future directions pertaining to prehospital induction of TH after SCA.
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Ther Hypothermia Temp Manag · Jan 2011
Induction of mild hypothermia by noninvasive body cooling in healthy, unanesthetized subjects.
The induction of mild hypothermia has been considered as an important means to provide protection against cerebral ischemia. Yet, to date, the relative clinical efficacies of different noninvasive methods for reducing core body temperature have not been thoroughly studied. The aim of the current investigation was to compare the relative effectiveness of several noninvasive cooling techniques for reducing core temperatures in healthy volunteers. ⋯ With each employed methodology, rectal temperature reductions were induced, with combined evaporative/conductive (n=4, 1.44°C±0.99°C) and convective/conductive (n=4, 1.51°C±0.89°C) approaches yielding the largest decreases: note, that evaporative cooling alone was not as efficient in lowering core body temperature (n=10, 0.56°C±0.20°C; n=16, 0.58°C±0.27°C). In this study on healthy volunteers, the evaporative/conductive and convective/conductive combination methods were more effective in reducing core temperatures as compared with an evaporative approach alone. These therapeutic approaches for the induction of mild hypothermia (including the use of facial warming) could be employed in warranted clinical cases, importantly without the need for administration of anesthetics or paralytics.
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The annual incidence of out-of-hospital cardiac arrests in the United States is ∼350,000-450,000 per year. The prognosis for cardiac arrest survivors remains extremely poor. ⋯ It reviews the contraindications to the use of this therapy, methods of cooling, and phases of TH and elaborates on the intensive care unit management of TH. The use of TH in ventricular fibrillation survivors has become the standard of care and continues to evolve in its application as an essential therapy in cardiac arrest patients.