PURPOSE: Induction of MTH in the post-cardiac arrest patient after return of spontaneous circulation improves survival and neurological function. Animal studies have shown that more rapid cooling correlates with better neurological outcome. We report a rapid hypothermia induction technique comprising a combination of cooling modalities using readily available, low-cost Intensive Care Unit (ICU) resources.
METHODS: 13 comatose post-cardiac arrest/post-anoxic event patients were cooled to a target temperature range of 32°C -34°C and maintained in target range for 24 hours. Cooling was begun immediately upon arrival to the ICU. All patients were sedated and paralyzed before hypothermia induction with fentanyl, midazolam and atracurium. Three cooling modalities were then begun simultaneously: 1) Evaporative cooling using a high flow fan on a fully exposed patient repeatedly wetted with room temperature water 2) rapid intravenous infusion of 55ml/kg chilled normal saline using a pressurized infusion bag via an 8 French introducer catheter placed in a femoral vein 3) repeated 500ml ice water gastric lavages via a nasogastric tube.
RESULTS: There were 13 patients (7 male, 6 female) in coma after cardiac arrest or anoxia event with an average age of 57 years. Time to reach 34°C after initiation of cooling modalities averaged 62 minutes. Average rate of cooling was 3.0°C/hr. Initial overshoot occurred in 6 patients (3 with nadir of 30°C -32°C and 3 with nadir 29°C -30°C). Cost of materials was approximately $110 per patient.
CONCLUSION: The combination of evaporative cooling, rapid infusion of chilled saline, and repeated ice water gastric lavages is a rapid and inexpensive way of inducing hypothermia. The cost and rate of cooling using this technique compares favorably with expensive commercial hypothermic devices.
CLINICAL IMPLICATIONS: A rapid and inexpensive therapeutic hypothermia protocol may promote more widespread and efficacious use of MTH in the post-arrest patient.
DISCLOSURE: Pierre Kory, No Financial Disclosure Information; No Product/Research Disclosure Information