A rapid, safe, and low-cost technique for the induction of mild therapeutic hypothermia in post-cardiac arrest patients |
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Authors: | Kory Pierre Weiner Justin Mathew Joseph P Fukunaga Mayuko Palmero Veronica Singh Bimaljeet Haimowitz Stephanie Clark Elana T Fischer Alyssa Mayo Paul H |
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Affiliation: | a Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Medical Center, 7th Floor Dazian Building, New York, NY 10003, United States b Internal Medicine Residency Program, Beth Israel Medical Center, 7th Floor Dazian Building, New York, NY 10003, United States c Albert Einstein College of Medicine, United States d Division of Pulmonary, Critical Care, and Sleep Medicine, North Shore - Long Island Jewish Medical Center, New Hyde Park, NY 11040, United States |
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Abstract: | Aim of studyThe benefits of inducing mild therapeutic hypothermia (MTH) in cardiac arrest patients are well established. Timing and speed of induction have been related to improved outcomes in several animal trials and one human study. We report the results of an easily implemented, rapid, safe, and low-cost protocol for the induction of MTH.MethodsAll in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients admitted to an intensive care unit meeting inclusion criteria were cooled using a combination modality of rapid, cold saline infusion (CSI), evaporative surface cooling, and ice water gastric lavage. Cooling tasks were performed with a primary emphasis on speed. The main endpoints were the time intervals between return of spontaneous circulation (ROSC), initiation of hypothermia (IH), and achievement of target temperature (TT).Results65 patients underwent MTH during a 3-year period. All patients reached target temperature. Median ROSC-TT was 134 min. Median ROSC-IH was 68 min. Median IH-TT was 60 min. IH-TT cooling rate was 2.6 °C/h. Complications were similar to that of other large trials. 31% of this mixed population of IHCA and OHCA patients recovered to a Pittsburgh cerebral performance score (CPC) of 1 or 2.ConclusionA protocol using a combination of core and surface cooling modalities was rapid, safe, and low cost in achieving MTH. The cooling rate of 2.6 °C/h was superior to most published protocols. This method uses readily available equipment and reduces the need for costly commercial devices. |
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Keywords: | MTH, mild therapeutic hypothermia IHCA, in-hospital cardiac arrest OHCA, out-of-hospital cardiac arrest CSI, cold saline infusion ROSC, return of spontaneous circulation IH, time of initiation of hypothermia TT, time target temperature achieved CPC, Pittsburgh-cerebral performance score VF, ventricular fibrillation VT, ventricular tachycardia MICU, medical intensive care unit |
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