Lessons in Transport - To Cool or Not to Cool?

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Chain of survival

Chain of survival

To COOL or NOT To COOL that is the question...

(Read each of the following scenarios & honestly ask yourself if this is a patient suitable for therapeutic hypothermia)

Scenario 1: 67 yo male scene STEMI, witnessed Vfib arrest with ROSC, GCS 3T, stable vitals

Scenario 2: 24 yo female MVC, ejected, hypotensive for EMS, 10 minute cardiac arrest with ROSC, GCS 3T

Scenario 3: 2 yo female cardiac arrest suspected choking, ROSC after removing food from her airway. GCS 4T (1T2)

Scenario 4: 18 yo male cardiac arrest suspected drug over dose, ROSC at outside hospital. GCS 9T (2T6)

Scenario 5: 30 yo female sudden onset of dyspnea then 30 min arrest with ROSC, hysterectomy 2 weeks ago, GCS 3T

Therapeutic Hypothermia Inclusion Criteria:

  • Cardiac arrest with return of spontaneous circulation (Note: any presenting rhythm can be cooled)

  • NOTfollowing commands

  • Trauma is NOTthe cause of cardiac arrest

  • No DNR/DNI

Hypothermia Exclusion Criteria:

  • Patient is currentlyfollowing commands

  • Trauma is the cause of cardiac arrest

  • Age < 15 yo (AT THIS TIME CCHMC IS NOT PERFORMING THERAPEUTIC HYPOTHERMIA FOR POST ARREST PEDIATRICS)

  • Known intracranial hemorrhage or stroke.

  • Active DNR/DNI paper

  • Hypothermia as the cause for the cardiac arrest. (These patients should be actively rewarmed)

Caution: these are cases that can still receive therapeutic hypothermia on a case-by-case basis but discussion with medical control or neurocritical care is advised before initiation of hypothermia

  • Major surgery within 1 week (ideal to discuss with surgeon first)

  • Female < 55 yo (consider pregnancy test prior to initiation of hypothermia)

  • Presenting temperature is < 32*C (and hypothermia is NOT the cause of the arrest)

  • Known intrinsic coagulopathy (Therapeutic anti-platelet or anticoagulation therapy is NOT a contraindication. Recommend discussing with neurocritical care before initiation)

  • Difficulty maintaining MAP > 70 mmHg (may use vasopressors as needed)

  • > 12 hours after ROSC

  • Pulselessness for greater than 60 minutes

***PEARL*** Save the attached UCMC inclusion and exclusion criteria to your mobile device for easy access

Therapeutic Hypothermia Inclusion Criteria

Authored by Ryan Gerecht, MD, CMTE and Diana Deimling, RN, BSN