At this stage of the game, if your hospital is not offering hypothermia to out-of-hospital cardiac arrests, you are probably lagging behind optimal care. For shockable rhythms, you essentially double your patient's chances of leaving the hospital with good neurological outcome. However hypothermia can be tough, unless you have done a bunch. Learn from my mistakes in this lecture.
I'd love to hear your comments and what you are doing at your hospital.
for more hypothermia resources, see my NYC Hypothermia Section
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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The sad part is this is also slow to take off in the pre-hospital setting as well. Especially in light of the literature, a lot states ( or whoever determines protocol) have not implemented this. Personally, any intervention that has been shown to benefit outcome deserves to be utilized. It should be noted that in the pre-hospital setting, this is not a very complicated therapy to learn and perform, especially when services like Wake County EMS and Richmond Ambulance Authority have paved the way with literature that backs up their increasing resuscitation rates. Hopefully, the AHA will wake up and… Read more »
You are so right. I have been lucky enough to be part of the NYC initiative to get hypothermia started in the field on every arrest patient. We will actually be starting intra-arrest cooling, which I think has great potential to improve outcome.
Scott
That is good news to hear. Also, do you use vasopressin on any arrest patients? I would be interested to hear your thoughts. It seems that it does not get utilized often because most do not want to draw it up , when a pre-filled syringe is easier.
I’ve been fairly underwhelmed with the vasopressin literature. I have been unimpressed with meds in general for arrest.
Cariporide is all I am aware of at the current time.
Agreed. Too many times I have pulses return because of massive amounts of drugs, only to have them code again or die as soon as they get to the ICU. However, there are not many other pharmacological options available that I am aware of. Personally, I think there is too much emphasis on pharmacological intervention with not enough convincing data. More focus needs to be placed on REAL high-quality CPR with little to no breaks. While on the subject, do you have an opinion on the future of sodium-hydrogen exchange inhibition?
Wow …I was searching google for esophageal temp probe insertion and I came right to your Blog and terrific video…I have subscribed to your website but my true focus if Pediatric Emergency Department and wonder if you also address Pediatric critical care issues or know of a similar website like yours that does…Your site is extremely valuable as we share tips and evidence based care. Thank you, Sue
only PED CCM I know of is the SCCM Icritical Care Podcast. Thanks for listening!
Hi Scott
LOVE your gig, a LOT of eyeopeners.
When do you use CardiacECMO/CPS for your cardiac arrest pts?
Have used it a couple of times in our center with succes, but only unprotocollised.
Regards Thomas
see the ECMO podcast on the site for the indications.