Today we are joined by Benjamin Abella, MD to discuss who to cool after cardiac arrest.
Who is Ben Abella?
Dr. Benjamin Abella is an Assistant Professor of Emergency Medicine and the Clinical Research Director of the Center for Resuscitation Science at the Perelman School of Medicine of the University of Pennsylvania. His research focuses on the clinical care of cardiac arrest victims, with a special emphasis on methods to improve the quality and training of cardiopulmonary resuscitation (CPR). He also maintains an active research program in the use of therapeutic hypothermia to improve survival after resuscitation from cardiac arrest. He is the medical director for the nation's only therapeutic hypothermia intensive training and certification course, based at the University of Pennsylvania. Dr. Abella also serves on the Medical Advisory Board of the Sudden Cardiac Arrest Association.
Want More?
- See the EMCrit Hypothermia Deep Dive
- Center for Resuscitation Science
- The free course Ben mentioned is starting in July
Additional New Information
More on EMCrit
EMCrit 307 – TTM2 Episode Retort with Ben Abella & Joe Tonna(Opens in a new browser tab)
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I’m having trouble downloading the episode from both iTunes and instacast
Never mind- its fixed
Hi Scott
A while back you mentioned “no cooling” for patients with a good prognosis – something along the lines of a good motor response / following commands after ROSC = no need for cooling.
You didn’t mention the ‘good prognosis’ side of who doesn’t need cooling in your scenarios in the podcast – can you clarify this for us?
Thanks
Casey
Yep, GCS of 6 on motor = no need to cool. That means the patient must be able to follow commands (i.e. “lift your right arm”).
Any evidence for therapeutic hypothermia for patients with in-hospital cardiac arrest yet?
only seen one abstract thus far:
in-house
EXCELLENT podcast – and a GREAT job by Dr. Abella. What I REALLY liked about Dr. Abella’s presentation is that despite obvious bias toward potential benefits of therapeutic hypothermia – he was completely open and receptive to questions and acknowledging of current limitations in the state of the art (as was Scott, who is another strong hypothermia advocate). The GOOD news is that therapeutic hypothermia appears to save/improve neurologic function in a certain number of victims from cardiac arrest who otherwise would have done much poorer (or would have died). HOW MANY such victims truly benefit (a key for determining… Read more »
brilliant summary, Ken
guys, loved every second of this!
Just interviewed a paramedic from Melbourne and heard about his service’s prehospital research into therapeutic hypothermia. He writes about it on his blog, prehospitalpro.com
What they found in an early study was that ED were more likely to continue cooling if it was initiated prehospital, just like Dr Abella surmised in the podcast.
@Minh Le Cong – It would seem DIFFICULT to stop cooling on arrival in the ED once it has been started in the field …
Again – this may or may not be a “good thing”. There are definite potential pros (ie, potential for improved prognosis) from initiation of protocols for automatic prehospital cooling – but also (as per my comment above) some potential negatives if universal protocols are adapted to automatically cool all code victims in the field. Wish I knew the answer …
In the NYC program, we all do it. EMS starts on everyone and then we decide whether to continue in the ED.
I enjoyed the interview, as usual. Just wanted to make a couple of comments. We are doing a pre-hospital randomized trial with pt’s (regardless of presenting rhythm) randomized to either immediate cooling with cold saline IV/IO group, or room temperature saline IV/IO until ROSC is achieved group. Everyone gets cold saline post-ROSC. (And by everyone I mean those that don’t meet exclusion criteria such as pediatrics, trauma, terminal condition, suspected intracranial or other hemorrhage, or pre-existing hypothermia). I suppose we’ll see if intra-arrest cooling makes a difference or not. The study is ongoing, so it may be a while. I… Read more »
Incredible Mike. Can’t wait to hear the results of the trial. NYC sends a supervisor to all arrests to supervise cooling. This means each arrest has 5 providers.
Amen Mike! Simply working them where we find them has made a huge difference in outcomes.
We have a similar protocol across the two services I work for, except one is using post-arrest cooling and one jumped on intra-arrest cooling. One favors early intubation without interruption (if a King isn’t in place) while the other favors an OPA and NRB for the first 3-4 cycles with either intubation or a King.
I too am looking forward to the results of your trial!
Hey Scott,
Great Podcast. Loved the added info and perspective given by Dr. Abella. Looking forward to further hypothermia information. Especially interested in the research in cases of ICH and post traumatic arrest. Sounds like a possible benefit in the case of reperfusion injury after cross clamping aorta. Is this part of the research you mentioned in this podcast?
Thank you to you both.
Jonathan
Hey buddy, So the post-traumatic arrest hypothermia at STC is currently being done after the pt leaves the OR, but I think your idea of peri-clamp hypothermia would have a lot of potential. It would be a tough balance of increased bleeding vs. decreased reperfusion injury.
Great talk, a lot of really interesting things in this podcast. Two comments/questions. 1) One of the comments asks about cooling patients who are responsive to some stimuli. In my opinion, dropping down from a high pre-arrest level of functioning/independence to a moderate level of functioning is a really, really bad outcome. Which is much worse than starting at a moderate level and dropping to a minimal level. Which is a much worse outcome from starting at a low pre-arrest condition and remaining there or becoming only minimally worse. So imagine the best case scenario of a young basketball player… Read more »
Matt, folks that are following commands at arrival to the hospital wind up with no significant deficits at all and therefore it would be unacceptable to expose them to the risks and costs of ther. hypothermia.
Sepsis is a relative, not an absolute contraindication. Septic patients don’t tolerate the hemodynamic changes of hypothermia very well, but the protective effects may eventually be proven.
What about the pt who is hypothermic before the arrest? Do we just warm them to 34c ish and then institute the remainder of the protocol?
thanks, mike
rewarm to 32-33 and proceed