Clinical paperA rapid, safe, and low-cost technique for the induction of mild therapeutic hypothermia in post-cardiac arrest patients☆
Introduction
The neurological and survival benefits of MTH in witnessed OHCA patients with ventricular fibrillation (VF) or ventricular tachycardia (VT) have been demonstrated in multiple randomized-controlled and historical-controlled trials over the past decade.1, 2, 3, 4, 5, 6 Consequently, the International Liaison Committee on Resuscitation and the American Heart Association recommend that comatose survivors of VF or VT after OHCA undergo MTH; and that this intervention may be beneficial in other rhythms.7, 8
Despite these recommendations, many centers have been slow to implement cooling protocols.9, 10, 11, 12, 13, 14 A major reason cited for the lack of MTH use was the belief that using MTH is too technically difficult and slow to administer. The perceived need for a commercial device-based protocol represents a significant barrier given the costs of such devices and the limited resources of many hospitals. We report the results of a hospital-based MTH protocol that is rapid, safe, and low-cost; as it utilizes simple equipment that is readily available in hospitals.
Section snippets
Methods
Beth Israel Medical Center is an 800-bed teaching hospital in New York City. The 16 bed medical intensive care unit (MICU) is a closed book unit that is run by a full time team with approximately 1200 admissions per year. The Beth Israel Medical Center Committee for the Protection of Human Subjects approved this study.
Results
A total of 65 patients received MTH. Patient characteristics are summarized in Table 3. All patients reached the target temperature range. The median ROSC–TT interval was 134 min. This interval decreased from a mean of 243 min over the first 6 months to a mean of 177 min over the final 30 months (p = .10). The median ROSC–IH interval was 68 min and the median IH–TT interval was 60 min. The cooling rate for the IH–TT interval was 2.6 °C/h (SD 1.6). Neurological outcomes of the patients are summarized in
Discussion
This study demonstrates that a protocol using rapid CSI, evaporative cooling, and ice water gastric lavage is a fast, safe, and low-cost technique for both reaching and maintaining post-cardiac arrest patients within a target temperature range of 32–34 °C for a period of 24 h. To our knowledge, this is the first report of a cooling protocol utilizing the simultaneous application of these three distinct cooling methods in post-cardiac arrest patients.
Rapid CSI is an effective and safe method for
Conclusions
Our combination cooling protocol is rapid, safe, and low cost. It can be implemented with readily available resources for successfully achieving target temperatures in post-cardiac arrest patients. A major strength of this protocol is its ability to achieve a fast cooling rate without the need for a costly commercial device.
Conflict of interest statement
No conflict of interest declared.
Acknowledgement
The authors thank Dr. Phillip Factor, Chief of the Division of Pulmonary, Critical Care, and Sleep Medicine for his assistance and support in the preparation of this manuscript.
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.08.020.