Theraputic Hypothermia after ROSC?

[Medic_QT]

I guess this could go in medical news?

As we all know, a lot of recent studies have supported theraputic induction of hypothermia after ROSC (return of spontaneous circulation).

We did an inservice last night at my department, and OSU Medical Center would like us to test it.. The problem is, the only time we ever transport to OSU is if we have a trauma. Also, for some reason our local bandaid station doesn't think we should ever pass them up (but we do), and they aren't OSU.

They want us to pack the patient's groin and airmpits with ice packs, then give a cooled (34-38 degree) fluid bolus of 30cc/Kg with a max of 2L.

At my ER, certain docs do this with continuous core temp monitoring and cooling blankets.

Does anyone do this now, or are there talks of ever doing it on your department? The issue is, once you start the hypothermia, you shouldn't stop it for 24-48 hours.


Oh well, I'm just wondering about your thoughts on it. I know certain procedures hit in certain areas before others (like CPAP.. nearly everyone has it around here), so I didn't know if you guys had it..

[BCoFD vollie]

from what I know of the issue the main barrier to EMS using this protocol is being able to effectively control the Pt's body temp.

[pros]

In Belgium some ICU use theraputic induction of hypothermia.
We never start in the ambulance, because (like BCoFD vollie says) it's to difficult to control the pt's body temperature

[jdemaio]

We're talking about it at work. I understand the point, however, I don't see the practical application in urban EMS. We have such short transport times, what kind of real impact will we be having? I'm not opposed to it, I think that it's a good idea and from what I've heard, it has GREAT results. I'm just a bit skeptical about the practicality vs benefit for those of us that have short transport times. I'm not 100% sold yet.

[Medic_QT]

I'm just a bit skeptical about the practicality vs benefit for those of us that have short transport times. I'm not 100% sold yet.

We were talking about it because depending on where you are in the county, you have a 10-20 minute transport to a bandaid station, then to a level 2 facility is 15-40 minutes depending where you are. It'd actually be feasible, because we usually take our post-arrests to the level 2's.

[musicemt]

As far as monitoring temp goes, I'm pretty sure both the ZOLL CCT series and the Lifepak 12 have continuous core temperature monitoring capabilities via a rectal thermometer. If that's not feasbile, I remember reading that when Seattle's Medic One service did their study with therapeutic hypothermia, their medics slipped a temperature probe down the esophagus when they intubated, and measured at a point where the probe's tip was near the right atrium.