Hypothermia Protocols and Resources

Protocols

Hypothermia/Post-arrest

If you are going to watch our videos below, it may be helpful to have a copy of our MSSM post-arrest protocol in front of you:

NY State Protocols

PCI Exemption

Links to Other Hypothermia and Post-Arrest Sites

Ben Bobrow’s Arizona Projects

University of Pennsylanvia’s Hypothermia Resources

Videos

 

Tips & Tricks

Mannitol Use During Hypothermia

(Ther Hypothermia 2011;1(2):107)

The intravenous administration of mannitol to a patient whose core temperature is 33C–37C will not result in crystallization of mannitol in the bloodstream. (Thomson-Reuters, 2011). For the patient who is being cooled with a central venous catheter that circulates chilled saline through balloons on the catheter, the manufacturer recommends that the machine be placed on standby for 2 minutes prior to the intravenous administration of mannitol. Pausing the machine for 2 minutes allows the blood flowing past the catheter to warm the catheter and prevent crystallization of mannitol. Then, mannitol with a concentration of 20% or less may be administered by intravenous push over the usual time.

Following administration of the mannitol, the central venous catheter is flushed with at least 10mL of sterile normal saline to rid the catheter of any remaining mannitol before returning the machine to the cooling mode. A mannitol concentration of greater than 20% or an infusion should be administered through a separate intravenous line (ZOLL Medical Corporation, 2011). If a surface cooling device such as a cooling blanket, pads, or wrapping device is in use and intravenous mannitol is needed, the device may be continued while administering the mannitol by infusion or injection. However, contact of the cooling device with the tubing of the mannitol infusion must be avoided to prevent crystallization. And, as usual with infusions of intravenous mannitol, an inline filter is needed (Gahart and Nazareno, 2009).

Another consideration around the concomitant use of mannitol and cooling is shifts in potassium. Both mannitol and cooling cause shifts in potassium. In a recent study, mannitol was shown to cause hypokalemia in 22% of patients on the first day of administration and up to 52.3% of patients with repeated dosing by day 3 (Seo and Oh, 2010). Mannitol-associated hypokalemia is thought to be due to the dilutional effect of mannitol caused by an intracellular to extracellular (intravascular) fluid shift (Seo and Oh, 2010). Cooling may also cause hypokalemia due to an extracellular to intracellular potassium shift (Polderman and Herold, 2009).

Need for Surgery during Therapeutic Hypothermia

(Ther Hypothermia 2011;1(2):107)

No increase in bleeding during intraop hypothermia for aneurysm clipping (N Engl J Med 2005;352:135–145)

Polderman et al. recommend platelets and dDAVP (Crit Care Med 2009;37:1101–1120)

May be at increased risk for surgical site infecitons

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