Induced Hypothermia Therapy

What is Induced Hypothermia?

Induced hypothermia is a treatment that improves the neurological outcomes and decreases the mortality rate in our post cardiac arrest patient population.

It can be used on the post cardiac arrest patient who has a return of spontaneous circulation (ROSC) yet neurologically is unresponsive. The American Heart Association has endorsed this treatment as a Class II recommendation, that it is acceptable, safe and considered effective, but true clinical effectiveness is not yet confirmed definitively.

Why Use Induced Hypothermia?

During cardiac arrest, decreased cerebral oxygen can occur as a result of hypotension or lack of perfusion, resulting in cerebral edema and neurological deficits. After successful resuscitation, reperfusion to the brain can exacerbate the edema and cause changes at the cellular level resulting in damaged brain cells and cell death.

Research has shown that mild hypothermia decreases cerebral edema and delays the cascading effects, which damage the brain cells resulting in improved neurological outcomes. Presently we do not offer this therapy for the post cardiac arrest patient who may meet the inclusion criteria.

What is The Process?

Once a patient survives an arrest and is deemed a candidate for this therapy, an "Induced Hypothermia Alert" will be called overhead, similar to other alerts currently in place. Once activated, a team will be notified and the patient will be transferred to an ICU as soon as possible, where the cooling pads will be applied and external cooling will begin. This therapy must be initiated within six hours of a return of spontaneous circulation.

The process may start in the field when emergency responders are called to the scene. In the field patients may be cooled with ice packs or chilled saline. The patient may come directly to the Cath Lab for PCI with the ice packs or chilled saline in place.  Once the Cath Lab procedure is completed the patient will be transferred to ICU for application of the cooling pads. Patients meeting certain criteria will be intentionally cooled externally to 33 degrees Celsius (91.4 F) for 24 hours after their arrest, then slowly rewarmed and allowed to wake up. The goal of this therapy is to preserve vital organs, most notably the neurological system, in the hopes of improving the cognitive and motor functions of these patients.