Therapeutic Hypothermia Robert Dortman Steven Lucynski Lauren Wynder

Therapeutic Hypothermia Robert Dortman, Steven Lucynski, & Lauren Wynder

Objectives After this presentation, the audience will be able to. . . 1. Identify indications for Therapeutic Hypothermia (TH) 2. Discuss contraindications for TH 3. Identify the complications & risks of TH 4. Address the nursing management of TH

Indications Cardiac arrest* Stroke Neonatal encephalopathy Spinal cord injury

Significance Improves neurological outcomes in post-cardiac arrest by decreasing cellular metabolism and oxygen demand Collaborative life-saving intervention

Nursing research Aim: to determine adherence and barriers to Therapeutic Hypothermia for out of hospital cardiac arrest patients Type of study: Retrospective chart audit over 12 months Results: 33 patients met inclusion criteria Only 4 at the goal temperature of 32. 5 -33. 5 C in target time of 2 hrs 17 not cooled at all Length of time prior to cooling varied = <1 hr (n=15)- >3 hr (n=5) 9 cooled for recommended time; 18 cooled to target temperature; 9/18 consistent with guidelines Implications: Poor education on management --->regular education sessions. Ready access to cooling agents

Types Invasive: cooling catheters, cooled blood and saline fluids Non-invasive: cooling blankets, cooling caps, ice packs, Arctic Sun Phases: 1. Cooling 2. Maintenance 3. Rewarming

When to initiate therapy Within 12 hours of the return of spontaneous circulation post cardiac arrest

Patient prep Begin sedation after decision for TTM has been made (goal: RASS -5) Arterial line and CVP line inserted Labs drawn Place temp probe x 2 no oral/axillary Skin assessment (esp posterior) Lowest room thermostat temperature

Arctic sun Non-invasive TTM system Pads are placed around patient’s legs and torso Pads circulate water that can cool and rewarm patients Can control body temperature within 0. 2°C

Inclusion criteria ET intubated & ventilated Arrived at facility within 6 hours & pulseless for less than 1 hour Resuscitated from cardiac arrest with an initial rhythm of VF, pulseless VT, pulseless electrical activity, or asystole GCS score <8 Hemodynamically stable (with or without vasopressors)

Exclusion criteria ◦Pregnant women ◦DNR and/or DNI ◦Sepsis ◦Significant trauma ◦Uncontrolled bleeding ◦Recent surgery ◦Severe bradycardia ◦Intracranial hemorrhage

Complications & Management ◦Prolonged PT & PTT; clotting factors depressed: Monitor Labs and obtain blood cultures ◦Skin breakdown: Assess skin ◦Shivering: NMBA, tylenol/demerol and/or bair hugger ◦Cardiac dysrhythmias r/t K + Ca: IV fluid replacement therapy ◦Changes renal blood flow and reduces sodium absorption: Strict intake and output monitoring

Complications & Management Changes renal blood flow and reduces sodium absorption: Strict intake and output monitoring Hyperglycemia: Glucose checks Infection: Administer broad spectrum antibiotics, maintain aseptic technique 10% in study showed critical hypotension: Administer vasopressors PRN

Conclusion Objectives Met? Identified indications for TTM Discussed contraindications for TTM Identified complications and risks TTM Addressed nursing management of TTM

Questions?

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Pirronen, K. , Tiainen, M. , Mustanoja, S. , Kaukonen, K. , Meretoja, A. , Tatlisumak, T. , & Kaste, M. Mild Hypothermia After Intravenous Thrombolysis in Patients With Acute Stroke: A Randomized Controlled Trial. Stroke, 486 -491. Presciutti, M. , Bader, M. K. , & Hepburn, M. (2012). Shivering Management During Therapeutic Temperature Modulation: Nurses' Perspective. Critical Care Nurse, 32(1), 33 -42. doi: 10. 4037/ccn 2012189 Products (2014). In Arctic Sun Temperature Management System. Retrieved December 1, 2014, from http: //www. medivance. com/Arctic. Sun 5000 Urden, L. , Stacy, K. , & Lough, M. (2014). Critical care nursing: Diagnosis and management (7 th ed). St. Louis, MO: Elsevier Mosby.