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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