Inservice in the Break Room: Therapeutic Hypothermia

On the topic of critical care, I thought we could bring up the idea of therapeutic hypothermia after cardiac arrest. We’re talking about a patient who comes in with v-fib or v-tach arrest (for less than 25-30 minutes) and is shocked, their rhythm is restored but they’re still not getting up. What to do?

Cooling the patient down to 32-34 C (metric system?!) has been shown to improve neurologic outcome by decreasing free radicals, cell death, calcium shifts and mitochondrial damage.

How to do it? Ice packs or cooled IV fluids, that’s about what we can do in the ER. The ICU may have some fancier devices, maybe be good to ask them what they do.

Watch out for

  • dysrhthmias (usually not too significant),
  • hyperglycemia (as insulin release is inhibited – also not usually too significant)
  • hyperkalemia
  • infection
  • seizures
  • hemorrhage

Basically, should we be putting IV bags in the fridge? What do you guys think? Have you seen an instance when we could have done this?