Tiffany Smith
Webliography
Therapeutic Hypothermia in Post Cardiac Arrest Patients
I chose to write my webliography on post cardiac arrest cooling because this is something that is fairly new in the medical field and it is very interesting. I also chose to research this topic because I have had to put this protocol into action a few times so far in my area, and I want to completely understand the reasoning why I am doing it. It is important to know the reasoning behind our actions especially when it comes to explaining those actions to family. Researching this topic will and has improved my knowledge on this subject and has allowed me to better understand it’s purpose.
Therapeutic Hypothermia is a protocol that is initiated after a patient has had a cardiac arrest incident and has been resuscitated. The main reason for doing this is to simply protect the brain. Research has shown that favorable and desired outcomes have occurred neurologically in these patients when this protocol has been initiated properly. Furthermore, preserving the brain by preventing reperfusion injury. There are three phases of cooling: induction, maintenance, and re-warming. The goal of induction is to decrease the temperature as rapidly as possible to get the temperature to 32-34 degrees Celsius (89-93 degrees F) with rapid infusion of ice-cold saline and cooling blankets. The importance of maintenance is to have a tight control of core temperature, monitored by a rectal probe or criticore foley catheter. Re-warming is slow, controlled, and is a time where the RN should monitor for electrolyte shifts, increased ICP, and other possibilities.
Hypothermia protects cerebral function by decreasing metabolic rate, cerebral oxygen demand, destructive enzymatic cascades, free radical production, cerebral edema and ICP. It also preserves the blood/brain barrier and suppresses the inflammatory response. These are all important components of the human body and it is essential that they be kept in balance. Important things to remember include: preventing skin damage, controlling shivering, avoiding hyperglycemia, avoiding electrolyte disorders, avoiding hypovolemia and hypotension, avoiding and treating infection, and using appropriate sedation, analgesia, and paralytics.
I chose sites for my webliography that were cited, professionally known, and that had evidence to back up their information. It is so important when looking for information, especially in our field, to get accurate and useful information. The American Heart Association is a well-known corporation to give accurate and useful information for the general population to use. Omni Medical Search is also a valid database that I used to ensure that the information I was using is accurate, up-to-date, and reliable.
All of my resources are intended to be used by health care providers who are using or intend to use the hypothermia protocol and are looking for studies conducted to back it up.
Intra-Arrest Cooling Improves Outcomes in a Murine Cardiac Arrest Model.
American Heart Association, Inc.
In this study, they used 3 groups of mice. The first group they induced hypothermia before attempted resuscitation, the second group the mice were cooled after resuscitation, and the third group they kept normothermic. The intra-arrest group, mice who received hypothermia just before resuscitation was initiated, had a better survival rate than the other two groups. Survival rate for the three groups included: 6/10, 1/10, and 1/10 with 6/10 being the best outcome with early hypothermia induction.
Heart and Vascular Center: Services: Hypothermia After Cardiac Arrest Protocol.
In the last four years, more than 50% of patients receiving the hypothermia treatment survived with a good neurological outcome. Use of the protocol started at MUSC started in 2008. They recommend slowly cooling and then re-warming over a period of 48 hours.
TREATMENT OF COMATOSE SURVIVORS OF OUT-OF-HOSPITAL CARDIAC ARREST WITH INDUCED HYPOTHERMIA
Treatment of patients with coma after resuscitation from out-of-hospital cardiac arrest is largely supported because cerebral ischemia may persist for several hours after resuscitation, and the use of hypothermia to decrease cerebral oxygen demand has been proposed as a treatment option. In this study, they had protocols set up to do hypothermia on some patients, and not on others. Discharging from the hospital to home or rehab after this was conducted was considered a good outcome. Discharge to a long term nursing facility was considered a bad outcome. In the hypothermia group, 49% had a good outcome. In the normothermia group, only 26% had a good outcome.
Rapid Head Cooling Initiated Coincident With Cardiopulmonary Resuscitation Improves Success of Defibrillation and Post-Resuscitation Myocardial Function in a Porcine Model of Prolonged Cardiac Arrest
Hypothermia has been shown to improve survival rate, neurological outcome, and even successfulness of defibrillation if started early. In this journal, they studied cardiac arrest with the cooling process in pigs. Overall, since the cooling process was initiated, the pigs required less doses of epinephrine, less defibrillation shocks, a higher success rate with shocks, and CPR duration was less. There were 8 control animals and 8 hypothermic animals. All 8 hypothermic pigs survived, but only 2 of the control group survived.
Hypothermia, Circulatory Arrest and Cardiopulmonary Bypass
This article discusses hypothermia focusing on neonates and infants. Hypothermia has many advantages such as organ function protection by decreasing metabolic rate and oxygen consumption. Many health care providers have come to accept this fairly new idea and have realized its value.
Post-Cardiac Arrest Care Key To Survival
This site discusses the cardiac arrest situation and interventions to improve outcomes. Along with the topic I decided to cover, this site goes along with the hypothermia protocol. Research has shown that we can improve outcomes and treat certain aspects of cardiac arrest damage. Hypothermia minimizes brain damage when cooled to 32034 degrees Celsius.
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