2.50
Hdl Handle:
http://hdl.handle.net/10755/162382
Type:
Presentation
Title:
Post Cardiac Arrest Clinically Induced Hypothermia
Abstract:
Post Cardiac Arrest Clinically Induced Hypothermia
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Hawkins, Jeanie, RN, BSN, MS, CEN
P.I. Institution Name:The Christ Hospital
Title:Clinical Manager
Contact Address:2139 Auburn Avenue, Cincinnati, OH, 45219, USA
Contact Telephone:513-585-1478
Co-Authors: Gail Merritt, RN, BS
[ENA Annual Conference - Evidence-based Practice Presentation]

Purpose: Post cardiac arrest clinically induced hypothermia (CIH) is an evidence based therapy that may improve neurological outcomes on some unconscious patients after sudden cardiac arrest who have return of spontaneous circulation (ROSC). Hospitalized patients who experience a cardiac arrest may be candidates for CIH which is instituted as soon as possible after transfer to the intensive care unit. Current evidence suggests that early use of mild hypothermia therapy in select populations of patients improves survival and neurological outcomes post discharge.

Design: Phase 1 of the project focused on preparing the staff for the CIH project. This included education on the pathophysiology/physiologic benefits of hypothermia, recognizing the potential candidates for CIH, care of the patient undergoing the therapy, use of the cooling equipment and potential complications. Phase 2 of the project was implementation and follow up of patients undergoing the therapy. This phase required coordination with the ED and ICUs for the development of protocols, standardized orders, transfer of patients and tracking outcomes.

Setting: The hospital is a 550 bed, tertiary care teaching hospital in a large Midwestern city with a major focus on cardiac care. The ED has over 49,000 visits per year. There are 4 ICUs where patients may undergo CIH (CCU, CSICU, SICU, or MICU). The hospital also has a well established eICU which provides medical and expert nursing surveillance and consultation for patients in all of the ICUs.

Participants/Subjects: Potential candidates for this therapy include: Cardiac arrest patients with the return of spontaneous circulation (ROSC), unresponsive after ROSC, endotracheal intubation with mechanical ventilation and blood pressure of at least 90 systolic with or without fluids or pressors. Exclusion criteria includes comatose for another reason, pregnancy, temperature of less than 30 degrees Celsius after cardiac arrest, pre-existing coagulopathy, DNR or cardiovascular dysrhythmias or refractory hypotension (use of pressors is not a contraindication)

Methods: Once a patient has been identified as a candidate for CIH the arterial line should be placed, baseline CBC, electrolytes, coag studies, magnesium, calcium and phosphorous should be drawn and sent to the lab. Two (2) methods of temperature monitoring esophageal temp probe and foley with temp probe need to be used. (If no urine output a rectal temp probe may be used) Target temperature for cooling is 32-34 degrees Celsius for 24 hours from initiation of cooling. This temperature is maintained for 24 hours from initiation of cooling. Rewarming to 37 degrees Celsius begins over and 8 hour period.

Results/Outcomes: In the 6 months since the initiation of CIH there have been 11 patients undergo the therapy. Of this number 6 have been discharged to home. A higher rate of patient enrollment is anticipated as awareness of the therapy spreads throughout the institution.

Implications: Clinically induced hypothermia is a viable, evidence based therapy that has been proven to improve neurological outcomes on some unconscious cardiac arrest patients and should begin in the ED. Hypothermic therapy can positively impact patient care and adverse neurologic outcomes.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePost Cardiac Arrest Clinically Induced Hypothermiaen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162382-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Post Cardiac Arrest Clinically Induced Hypothermia</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Hawkins, Jeanie, RN, BSN, MS, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">The Christ Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2139 Auburn Avenue, Cincinnati, OH, 45219, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">513-585-1478</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jeanie.hawkins@thechristhospital.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value"> Gail Merritt, RN, BS</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation]<br/><br/>Purpose: Post cardiac arrest clinically induced hypothermia (CIH) is an evidence based therapy that may improve neurological outcomes on some unconscious patients after sudden cardiac arrest who have return of spontaneous circulation (ROSC). Hospitalized patients who experience a cardiac arrest may be candidates for CIH which is instituted as soon as possible after transfer to the intensive care unit. Current evidence suggests that early use of mild hypothermia therapy in select populations of patients improves survival and neurological outcomes post discharge. <br/><br/>Design: Phase 1 of the project focused on preparing the staff for the CIH project. This included education on the pathophysiology/physiologic benefits of hypothermia, recognizing the potential candidates for CIH, care of the patient undergoing the therapy, use of the cooling equipment and potential complications. Phase 2 of the project was implementation and follow up of patients undergoing the therapy. This phase required coordination with the ED and ICUs for the development of protocols, standardized orders, transfer of patients and tracking outcomes.<br/><br/>Setting: The hospital is a 550 bed, tertiary care teaching hospital in a large Midwestern city with a major focus on cardiac care. The ED has over 49,000 visits per year. There are 4 ICUs where patients may undergo CIH (CCU, CSICU, SICU, or MICU). The hospital also has a well established eICU which provides medical and expert nursing surveillance and consultation for patients in all of the ICUs. <br/><br/>Participants/Subjects: Potential candidates for this therapy include: Cardiac arrest patients with the return of spontaneous circulation (ROSC), unresponsive after ROSC, endotracheal intubation with mechanical ventilation and blood pressure of at least 90 systolic with or without fluids or pressors. Exclusion criteria includes comatose for another reason, pregnancy, temperature of less than 30 degrees Celsius after cardiac arrest, pre-existing coagulopathy, DNR or cardiovascular dysrhythmias or refractory hypotension (use of pressors is not a contraindication)<br/><br/>Methods: Once a patient has been identified as a candidate for CIH the arterial line should be placed, baseline CBC, electrolytes, coag studies, magnesium, calcium and phosphorous should be drawn and sent to the lab. Two (2) methods of temperature monitoring esophageal temp probe and foley with temp probe need to be used. (If no urine output a rectal temp probe may be used) Target temperature for cooling is 32-34 degrees Celsius for 24 hours from initiation of cooling. This temperature is maintained for 24 hours from initiation of cooling. Rewarming to 37 degrees Celsius begins over and 8 hour period. <br/><br/>Results/Outcomes: In the 6 months since the initiation of CIH there have been 11 patients undergo the therapy. Of this number 6 have been discharged to home. A higher rate of patient enrollment is anticipated as awareness of the therapy spreads throughout the institution.<br/><br/>Implications: Clinically induced hypothermia is a viable, evidence based therapy that has been proven to improve neurological outcomes on some unconscious cardiac arrest patients and should begin in the ED. Hypothermic therapy can positively impact patient care and adverse neurologic outcomes. <br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:14Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:14Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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