Therapeutic Hypothermia May Be Cost-Effective Postresuscitation Option

[Sasha]

Currently I am not aware of any local EMS agency in my area that uses therapuetic hypothermia, although it seems to be effective. I'm wondering if any of you use hypothermia protocols? If so, what are your protocols for it?

Therapeutic Hypothermia May Be Cost-Effective Postresuscitation Option
Full Article: http://www.medpagetoday.com/Emergenc...Medicine/15382

On paper, therapeutic hypothermia after out-of-hospital cardiac arrest appears to save lives and improve neurologic outcomes at a cost comparable to other more conventional therapies, according to findings published today.

Mathematical modeling determined that hypothermia using a cooling blanket resulted in patients gaining an average of 0.66 quality-adjusted life years (QALY) (95% CI 0.11 to 1.3) compared with conventional care, wrote Raina M. Merchant, MD, of the University of Pennsylvania, and colleagues. The findings were published online in Circulation: Cardiovascular Quality and Outcomes.


The incremental cost was $31,254 (95% CI $5,581 to $77,553), resulting in an incremental cost effectiveness ratio of $47,168 (95% CI $16,673 to $191,369) per QALY.


Therapeutic hypothermia, in which the body temperature is lowered to 32° to 34°C for 12 to 24 hours, is the only postresuscitation therapy that has been shown to improve outcomes in patients with witnessed out-of-hospital cardiac arrest.

[Dark Angel]

We have a hypothermia protocol for ROSC patients who remain comatose. We don't have a blanket, like mentioned in the article, but we do carry iced saline. For patients that meet the criteria of the protocol, we hook up the iced saline and run it in.

Here's our protocol for it. Pretty simple and straight forward.

POST CARDIAC ARREST HYPOTHERMIA PROTOCOL

A. For return of spontaneous circulation (ROSC), continue supportive care and transport
promptly.

B. If possible, infuse iced 0.9% saline through an 18 ga (or larger) IV into patients who
remain comatose.

1. Infuse up to 2,000 ml using a pressure bag inflated to 300 mmHg.

2. Avoid in patients in whom cardiac arrest is thought to be due to hypothermia or
trauma, and in women who are obviously pregnant.

[Ditch Doc]

Wake County (Raleigh) is using it for both ROSC and STEMI. Here's a link with some info. http://www.wakeems.com/ICE/Induced%2...0Job%20Aid.pdf

[Dark Angel]

So, how is it working for STEMIs? I have heard of that being done, but no one does it prehospitally around here that I am aware of. There have been some trials with inpatients though. I also had the opportunity to attend an audit & review where the speaker for the first portion of it was a neurologist that said they are looking at trying hypothermia as a treatment for some CVAs. He sounded pretty excited about the promise of significantly slowing the damage done in certain patients.

[Reaper]

Our Protocols are basically the same as Wakes. One hospital is very restrictive on what they will take. Other hospital will take anyone we feel is a candidate for ICE. It has shown some promise, only time will tell.

[PSYCtest040]

My region has no field post resuscitation hypothermia protocols, it's all done in the ED.

[Sasha]

We have a hypothermia protocol for ROSC patients who remain comatose. We don't have a blanket, like mentioned in the article, but we do carry iced saline. For patients that meet the criteria of the protocol, we hook up the iced saline and run it in.

Here's our protocol for it. Pretty simple and straight forward.

POST CARDIAC ARREST HYPOTHERMIA PROTOCOL

A. For return of spontaneous circulation (ROSC), continue supportive care and transport
promptly.

B. If possible, infuse iced 0.9% saline through an 18 ga (or larger) IV into patients who
remain comatose.

1. Infuse up to 2,000 ml using a pressure bag inflated to 300 mmHg.

2. Avoid in patients in whom cardiac arrest is thought to be due to hypothermia or
trauma, and in women who are obviously pregnant.

I'm wondering a) what effect hypothermia would have on the fetus s/p arrest and b) if the IV accidently infiltrates would the iced saline damage the tissue?

[Ditch Doc]

So, how is it working for STEMIs?

From what I have been told, it has been extremely successful. Many of the ROSC patients have been discharged with no neuro deficit. The STEMI-cicles have had great outcomes as well. I do not have the numbers in front of me, but I am sure you can google it.... the program is being headed by Brent Myers, MD. He's Wake EMS' medical director.

We are not yet cooling patients in the field in my county, but we do transport STEMI's to the heart center that is involved in Wake's study. While our STEMI's are not cooled until they get to the ED, the outcomes are still very positive.... more so than before. Hypothermia seems to be making a difference and will most likely go way beyond being just a study.