What are the risks of therapeutic hypothermia after cardiac arrest?
The lack of blood flow can cause lasting damage to the brain. The person may be unable to regain consciousness. Lowering the body temperature right away after cardiac arrest can reduce damage to the brain. That raises the chances that the person will recover.
What is an absolute contra indication to targeted temperature management?
Further, they recommend selecting and maintaining a constant temperature between 32 degrees C and 36 degrees C during TTM. Absolute contraindications to TTM are an awake and responsive patient, DNR, active non-compressible bleeding and the need for immediate surgery.
Which alteration to the standard ACLS algorithm is appropriate for patients whose cardiac arrest is caused by hypothermia?
Alterations to ACLS: Epinephrine and other vasoactive medications may have decreased efficacy and increased concentrations during hypothermia. Consider withholding ACLS medications until a core temperature of 30oC is reached, and then doubling the interval of dosing until normothermia is achieved.
What type of patient is eligible for a therapeutic hypothermia protocol intervention?
Therapeutic Hypothermia (TH) shall be initiated on all adult cardiac arrest patients with return of spontaneous circulation (ROSC) that fit the inclusion criteria, and does not have any of the following: eye opening to painful stimuli, pre-existing coma, traumatic arrest (either penetrating or blunt), body temperature …
What agents are no longer recommended for routine post cardiac arrest care?
Standard-dose epinephrine (1 mg every 3-5 min) may be reasonable for patients in cardiac arrest (class IIb); high-dose epinephrine is not recommended for routine use in cardiac arrest (class III)
What is the goal temperature for therapeutic hypothermia?
In most centers, the patient is actively cooled by using an induced hypothermia protocol for 24 hours to a goal temperature of 32ºC-36ºC. The goal is to achieve the target temperature as quickly as possible. In most cases, this can be achieved within 3-4 hours of initiating cooling.
Which therapy is not supported in patients with cardiac arrest secondary to hypothermia?
Defibrillation and pacing Defibrillation is less effective in hypothermia. For ventricular fibrillation/ventricular tachycardia (VF/VT) defibrillation may be tried up to three times but is then not tried until the temperature reaches 30 C. Pacing is generally ineffective.
When caring for a severely hypothermic patient who is in cardiac arrest you should?
Hypothermic cardiac arrest care should focus on excellent CPR while not exposing the patient to more heat loss than necessary. If the patient is in v fib, one shock and one round of medications should be delivered.
When to use therapeutic hypothermia after cardiac arrest?
Use of therapeutic hypothermia should include comatose survivors of cardiac arrest associated initially with nonshockable rhythms and shockable rhythms. The lower level of evidence for use after cardiac arrest from nonshockable rhythms is acknowledged.
What should the temp be after cardiac arrest?
Summary of Practice Guideline Recommendations for Therapeutic Hypothermia Comatose (ie, lack of meaningful response to verbal commands) adult patients with ROSC after out-of-hospital VF cardiac arrest should be cooled to 32°C–34°C (89.6°F–93.2°F) for 12 to 24 h ( Class I; Level of Evidence: B ).
Are there any true contraindications for th use?
Contraindications There are few true contraindications for TH. Medical conditions in which the risk may be excessive include documented intracranial hemorrhage, severe hemorrhage leading to exsanguination, hypotension refractory to multiple vasopressors, severe sepsis, and pregnancy.
What should target temperature be for hospital admission?
Patients who are at the target temperature on admission to the hospital should be maintained using cooling measures described in this guideline. If below the target temperature on admission, patient can be maintained at the closest available targeted temperature 33 or 36 C to avoid “rewarming” during acute insult.