Guest guest Posted April 19, 2008 Report Share Posted April 19, 2008 Greetings; I have recently been asked if I am aware of a " Cool Down " period in CPR and I believe this may be related to ACLS. The last I heard of anything is the possibility of sending our patients into hypothermia during the resuscitation in ACLS. Is this the same " Cool Down " period or is there another reference I need more information on? I know that there is at least a couple of our learned brethren or sisters that would have information on this. Any and all information is greatly appreciated. Thank You. Danny L. Owner/NREMT-P PETSAR INC. (Panhandle Emergency Training Services And Response) Office Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2008 Report Share Posted April 21, 2008 Kenny, If they DO wake up following resuscitation, is induced hypothermia still recommended? Gene G. In a message dated 4/21/08 7:48:51 PM, kenneth.navarro@... writes: > > >>> The last I heard of anything is the possibility of sending our > patients into hypothermia during the resuscitation in ACLS. <<< > > Danny, > > In 2 randomized clinical trials, induced hypothermia within minutes > to hours after ROSC to a temperature between 32°C and 34°C (89.6°F to > 93.2°F) for 12 to 24 hours) resulted in improved outcome > in adults who remained comatose after initial resuscitation > from out-of-hospital ventricular fibrillation (VF) cardiac arrest. > > A third study documented improvement in metabolic end points when > comatose adult patients were cooled after ROSC from out-of-hospital > cardiac arrest in which the initial rhythm was pulseless electrical > activity (PEA)/asystole. This study was not designed to measure > neurological outcome, therefore it is unclear if the observed > improvement resulted in improved outcome. > > The studies used external cooling techniques (eg, cooling blankets > and frequent applications of ice bags) along with cold saline > infusions. > > Based on this data, the American Heart Association recommends: > > Providers should not actively rewarm hemodynamically stable patients > who spontaneously develop a mild degree of hypothermia (> 33°C > [91.5F]) after resuscitation from cardiac arrest. (Permissive > hypothermia - paraphrased - Don't warm them if they get cold on their > own.) > > For the unconscious adult patient with ROSC after out-of-hospital > cardiac arrest, actively cool to 32°C to 34°C (89.6°F to 93.2°F) for > 12 to 24 hours when the initial rhythm was VF (Class IIa). (Induced > hypothermia - paraphrased - If they don't wake up quickly after ROSC, > cool them down quickly.) > > Similar therapy may be beneficial for patients with non-VF arrest out > of hospital or for in-hospital arrest (Class IIb). > > Induced hypothermia following VF is a higher class rating than > epinephrine, amiodarone, endotracheal intubation, or lidocaine. > > Hope this helps. > > Kenny Navarro > UT Southwestern Medical Center at Dallas > > > ************** Need a new ride? Check out the largest site for U.S. used car listings at AOL Autos. (http://autos.aol.com/used?NCID=aolcmp00300000002851) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2008 Report Share Posted April 21, 2008 >>> The last I heard of anything is the possibility of sending our patients into hypothermia during the resuscitation in ACLS. <<< Danny, In 2 randomized clinical trials, induced hypothermia within minutes to hours after ROSC to a temperature between 32°C and 34°C (89.6°F to 93.2°F) for 12 to 24 hours) resulted in improved outcome in adults who remained comatose after initial resuscitation from out-of-hospital ventricular fibrillation (VF) cardiac arrest. A third study documented improvement in metabolic end points when comatose adult patients were cooled after ROSC from out-of-hospital cardiac arrest in which the initial rhythm was pulseless electrical activity (PEA)/asystole. This study was not designed to measure neurological outcome, therefore it is unclear if the observed improvement resulted in improved outcome. The studies used external cooling techniques (eg, cooling blankets and frequent applications of ice bags) along with cold saline infusions. Based on this data, the American Heart Association recommends: Providers should not actively rewarm hemodynamically stable patients who spontaneously develop a mild degree of hypothermia (> 33°C [91.5F]) after resuscitation from cardiac arrest. (Permissive hypothermia - paraphrased - Don't warm them if they get cold on their own.) For the unconscious adult patient with ROSC after out-of-hospital cardiac arrest, actively cool to 32°C to 34°C (89.6°F to 93.2°F) for 12 to 24 hours when the initial rhythm was VF (Class IIa). (Induced hypothermia - paraphrased - If they don't wake up quickly after ROSC, cool them down quickly.) Similar therapy may be beneficial for patients with non-VF arrest out of hospital or for in-hospital arrest (Class IIb). Induced hypothermia following VF is a higher class rating than epinephrine, amiodarone, endotracheal intubation, or lidocaine. Hope this helps. Kenny Navarro UT Southwestern Medical Center at Dallas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 23, 2008 Report Share Posted April 23, 2008 >>> If they DO wake up following resuscitation, is induced hypothermia still recommended? <<< Gene, Guidelines 2005 do not address sedation and hypothermia for patients who quickly regain some level of consciousness following ROSC. Perhaps early cognitive function following ROSC suggests minimal neurological insult rendering the potential benefits of hypothermia moot. However, since guidelines 2005 were published . . . The French reported the results of a trial of 33 patients cooled during the resuscitation attempt instead of waiting for ROSC. EMS administered 2 liters of cold saline by rapid infusion as soon as possible after obtaining IV access. If ROSC occurred, medics administered ketamine for sedation and atracurium to prevent shivering. Twenty (60%) ultimately achieved ROSC and were admitted to the ICU. Doctors maintained hypothermia for 24 hours before rewarming. At six months post cardiac arrest, four were still alive and two had favorable neurological outcomes. Researchers in Germany have investigated the impact of percutaneous coronary revascularization (PCI) during therapeutic hypothermia following cardiac arrest. Doctors induced hypothermia in 31 comatose patients admitted to the ICU with out-of-hospital cardiac arrest due to AMI. PCI occurred during the hypothermic state. Researchers matched the patients to 31 historical controls admitted in the era prior to hypothermia treatment. In the hypothermia group, 19 patients were discharged with a favorable neurological outcome, whereas in controls, such outcome was observed in only six patients (p=0.002). Finally, a contraindication to the use of therapeutic hypothermia after cardiac arrest has always been pregnancy. However, a case reported in Critical Care Medicine describes a 35-yr-old woman who, at 13 weeks gestation, had a witnessed out-of-hospital ventricular fibrillation cardiac arrest. EMS successfully resuscitated the gravid woman and delivered her comatose to the hospital. The hospital initiated therapeutic cooling (33°C) for 24 hrs and she was discharged home with mild neurologic deficit on hospital day 6. At 39 weeks gestation, delivery of the infant occurred via cesarean section. APGAR scores were 8 and 9, and neurodevelopmental testing was appropriate for age at birth and at 2 months. Kenny Navarro UT Southwestern Medical Center at Dallas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 25, 2008 Report Share Posted April 25, 2008 Does it seem as if the french do a lot of EMS studies? LNM Sent via BlackBerry by AT & T Re: CPR Question >>> If they DO wake up following resuscitation, is induced hypothermia still recommended? <<< Gene, Guidelines 2005 do not address sedation and hypothermia for patients who quickly regain some level of consciousness following ROSC. Perhaps early cognitive function following ROSC suggests minimal neurological insult rendering the potential benefits of hypothermia moot. However, since guidelines 2005 were published . . . The French reported the results of a trial of 33 patients cooled during the resuscitation attempt instead of waiting for ROSC. EMS administered 2 liters of cold saline by rapid infusion as soon as possible after obtaining IV access. If ROSC occurred, medics administered ketamine for sedation and atracurium to prevent shivering. Twenty (60%) ultimately achieved ROSC and were admitted to the ICU. Doctors maintained hypothermia for 24 hours before rewarming. At six months post cardiac arrest, four were still alive and two had favorable neurological outcomes. Researchers in Germany have investigated the impact of percutaneous coronary revascularization (PCI) during therapeutic hypothermia following cardiac arrest. Doctors induced hypothermia in 31 comatose patients admitted to the ICU with out-of-hospital cardiac arrest due to AMI. PCI occurred during the hypothermic state. Researchers matched the patients to 31 historical controls admitted in the era prior to hypothermia treatment. In the hypothermia group, 19 patients were discharged with a favorable neurological outcome, whereas in controls, such outcome was observed in only six patients (p=0.002). Finally, a contraindication to the use of therapeutic hypothermia after cardiac arrest has always been pregnancy. However, a case reported in Critical Care Medicine describes a 35-yr-old woman who, at 13 weeks gestation, had a witnessed out-of-hospital ventricular fibrillation cardiac arrest. EMS successfully resuscitated the gravid woman and delivered her comatose to the hospital. The hospital initiated therapeutic cooling (33°C) for 24 hrs and she was discharged home with mild neurologic deficit on hospital day 6. At 39 weeks gestation, delivery of the infant occurred via cesarean section. APGAR scores were 8 and 9, and neurodevelopmental testing was appropriate for age at birth and at 2 months. Kenny Navarro UT Southwestern Medical Center at Dallas ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2008 Report Share Posted May 4, 2008 Kenny: I appologize for not thanking you earlier for your input, Thank You. Is this what is referred to as the " cooling down period " or was there another reference I am not aware of that pertains to that particular grouping of words? I was not particularly sure what the indivdual I spoke to was referencing. This appeared to be the closest I could remember. Kenny Navarro wrote: >>> The last I heard of anything is the possibility of sending our patients into hypothermia during the resuscitation in ACLS. <<< Danny, In 2 randomized clinical trials, induced hypothermia within minutes to hours after ROSC to a temperature between 32°C and 34°C (89.6°F to 93.2°F) for 12 to 24 hours) resulted in improved outcome in adults who remained comatose after initial resuscitation from out-of-hospital ventricular fibrillation (VF) cardiac arrest. A third study documented improvement in metabolic end points when comatose adult patients were cooled after ROSC from out-of-hospital cardiac arrest in which the initial rhythm was pulseless electrical activity (PEA)/asystole. This study was not designed to measure neurological outcome, therefore it is unclear if the observed improvement resulted in improved outcome. The studies used external cooling techniques (eg, cooling blankets and frequent applications of ice bags) along with cold saline infusions. Based on this data, the American Heart Association recommends: Providers should not actively rewarm hemodynamically stable patients who spontaneously develop a mild degree of hypothermia (> 33°C [91.5F]) after resuscitation from cardiac arrest. (Permissive hypothermia - paraphrased - Don't warm them if they get cold on their own.) For the unconscious adult patient with ROSC after out-of-hospital cardiac arrest, actively cool to 32°C to 34°C (89.6°F to 93.2°F) for 12 to 24 hours when the initial rhythm was VF (Class IIa). (Induced hypothermia - paraphrased - If they don't wake up quickly after ROSC, cool them down quickly.) Similar therapy may be beneficial for patients with non-VF arrest out of hospital or for in-hospital arrest (Class IIb). Induced hypothermia following VF is a higher class rating than epinephrine, amiodarone, endotracheal intubation, or lidocaine. Hope this helps. Kenny Navarro UT Southwestern Medical Center at Dallas Danny L. Owner/NREMT-P PETSAR INC. (Panhandle Emergency Training Services And Response) Office Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2008 Report Share Posted May 4, 2008 >>> Is this what is referred to as the " cooling down period " or was there another reference I am not aware of that pertains to that particular grouping of words? I was not particularly sure what the indivdual I spoke to was referencing. This appeared to be the closest I could remember.<<< Danny, I'm not sure what the term " cooling down period " is meant to imply during resuscitation. The only thing I am aware of that even closely resembles cooling in cardiac arrest resuscitation is therapeutic hypothermia. Kenny Navarro Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2008 Report Share Posted May 5, 2008 Kenny; Thank You. I too have only heard of the hypothermia post rescusitation. I was just making sure I have not missed anything. Kenny Navarro wrote: >>> Is this what is referred to as the " cooling down period " or was there another reference I am not aware of that pertains to that particular grouping of words? I was not particularly sure what the indivdual I spoke to was referencing. This appeared to be the closest I could remember.<<< Danny, I'm not sure what the term " cooling down period " is meant to imply during resuscitation. The only thing I am aware of that even closely resembles cooling in cardiac arrest resuscitation is therapeutic hypothermia. Kenny Navarro Danny L. Owner/NREMT-P PETSAR INC. (Panhandle Emergency Training Services And Response) Office Fax Quote Link to comment Share on other sites More sharing options...
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