Therapeutic Hypothermia Mortality

For more than a decade, Targeted Temperature Management (TTM) has been the recommended treatment modality in adult comatose patients following out-of-hospital cardiac arrest (OHCA)[1] in order to improve survival and neurological outcome by minimizing brain injuries due to anoxia and reperfusion injury.

Purpose: The purpose of this speech is to educate and inform my audience of the risks inherent from unintended hypothermia. I’m eager to alert perioperative staff of the potential dangers as well as the preventative measures that can be taken in order to avoid complications associated with unintended hypothermia. My central idea is hypothermia management saves lives.

While numbers from the study may appear to show a positive improvement, the account of out-of-hospital neurological and physical deficits arising from the event are not shown throughout the study and need to be taken into consideration. The American Heart Association acknowledges the study and also acknowledges that there is not enough evidence to support they use or the lack of ACLS medications during a cardiac arrest.

The next resuscitation attempt was to put the subject in a warm bath, whose temperature would gradually increase so as not to make the subject die from shock. The warm bath method was proven the

THT is the only therapy that has appeared to positively affect the neurological outcome of patients after cardiac arrest. THT has been around for more than fifty years. The history of the scope of THT is limited and the only consistent application of this therapy invasive surgery. Within the last 10 years, the benefits of induced therapeutic hypothermia have been rediscovered, mainly with the improvement in neurological outcomes in out-of-hospital cardiac arrest (OOHCA) victims. In addition, therapeutic hypothermia has been suggested to improve outcome in other neurological conditions such as traumatic brain injury, neonatal asphyxia, cerebrovascular accidents and intracranial

The aim of the final phase of this therapy is to gradually rewarm the patient to the normal body temperature of 37 °C. Gradual rewarming of the patient is strongly recommended as rewarming the patient too quickly can cause a number of adverse side effects such as a sudden arrhythmia that can cause electrolyte shifts, hypoglycemia, and hypotension. Neuromuscular blockers are often administered in conjunction with rewarming to prevent shivering thermogenesis, which can lead to sudden electrolyte disturbances. An ideal rate of rewarming of 0.15 °C to 0.25 °C per hour is recommended in order to minimize the adverse side effects associated with this phase (Peberdy et al., 2010, S770).

Perioperative hypothermia causes adverse effects in the recovery of a post-operative patient. These well known effects include delayed anaesthetic recovery, increased incidence and duration of postoperative ventilation, increased blood loss and transfusion requirements, increased cardiac events, increased surgical wound infection, pro-longed hospital length-of-stay (LOS) and higher hospital mortality.

The evidence surrounding the topic of therapeutic hypothermia post cardiac arrest is one lathered in potentially advantageous benefits, as well as harmful side effects. Although this procedure has potentially lifesaving and neurologically preserving implications, it does come with various side effects which can be dangerous in general or if left untreated. This paper will first address the many benefits, some of which include prolongation of life, retention of neurological function. It will then shed light upon some of the subsequent risks and harmful effects that are associated with therapeutic hypothermia. Lastly the paper will discuss why or why not the overall benefits outweigh the aggravating factors. Thus, being a topic of much controversy

(Karmiova, 2001) and is predictive of subsequent multiple organ failure, infection and than eventually death in these patients. These conditions have many features common with sepsis. Blood concentrations of various cytokines, soluble receptors and endotoxins increase within as early as 3 hours after cardiac arrest, the magnitude of these changes is associated with the outcome. Activation of blood coagulation without adequate activation of endogenous fibrinolysis is an important pathophysiological mechanism that may contribute to microcirculatory reperfusion disorders (Böttiger, 1995). For patients that undergo CPR and achieve ROSC, their coagulation/anticoagulation and fibrinolysis/antifibrinolsis systems are activated. Anticoagulant factors such as antithrombin, protein S and protein C are decreased and this decrease is associated with transient increases in endogenous activated protein C after resuscitation (Adrie,2005). The stress of total-body oxygen debt also affects adrenal production and function. Although patients have increased plasma cortisol levels they have a relative adrenal insufficiency defined as failure to respond to corticotrophin. This failure to respond causes the adrenal cortex to not be stimulated to secrete the hormones necessary to respond to stress.

David Casarett, there are many ways to preserve life after cardiac arrest. He says that all this research has led to most things used today that keep us alive longer. One of these things were Researchers at the University of Pittsburgh’s Safar Center chilling dogs at a very low temperature that helped keep them alive after cardiac arrest. He states that these studies have led to clinical trials that are designed to save patients who wouldn’t survive with conventional treatment.

Hypothermia has two main types of causes. It classically occurs from exposure to extreme cold. Commonly this includes alcohol intoxication but may also include low blood sugar, anorexia, and advanced age. Hypothermia may be diagnosed based on either a person's symptoms in the presence of risk factors or by measuring a person's core temperature. One of the lowest documented body temperatures from which someone with accidental hypothermia has survived is in a near-drowning of a 7-year-old girl in Sweden. Survival after more than six hours of CPR has been described. Symptoms of mild hypothermia may be vague, Increased urine production due to cold, mental confusion, and hepatic dysfunction may also be present. Hyperglycemia may be present, as glucose consumption by cells and insulin secretion both decrease, and tissue sensitivity to insulin may be blunted. Sympathetic activation also releases glucose from the liver. In many cases, however, especially in alcoholic patients, hypoglycemia appears to be a more common presentation. Low body temperature results in shivering becoming more violent. Muscle mis-coordination becomes apparent. Movements are slow and labored, accompanied by a stumbling pace and mild confusion, although the person may appear alert. Surface blood

The extreme environment in which rescues of this nature take place also contribute to a patient’s difficulty in surviving. Patients are typically critically injured, and in need of a speedy rescue. For instance, hypothermia can set in very quickly in cold water. This condition causes a patient’s mobility to become limited due to a dropping core temperature. It means the survivor is often unable to help and that means the rescue becomes more challenging for the rescue swimmer. (USCG RS Manual; knowledge of

Without early intervention on average 360,000 people out of the hospital succumb to cardiac arrest. “ Cardiac arrest and sudden death account for 60 percent of all deaths from coronary artery disease”,(Bledsoe, Porter, & Cherry, 2011,2007,2004, p. 1229)There are several causes of sudden cardiac arrest. Most are caused by ventricular fibrillation. “During ventricular fibrillation, the ventricles do not beat normally. Instead they quiver rapidly and irregularly.” When this occurs, the heart pumps very little and blood does not get circulated throughout the body. “ Most of the cases found with sudden cardiac death are related to undetected cardiovascular disease.("Sudden Cardiac Death," 2015, para. 2)Sudden cardiac arrest are immediate and drastic that includes sudden collapse, no pulse, not breathing, and loss of consciousness. “Four rhythms produce pulseless cardiac arrest: ventricular fibrillation, rapid ventricular tachycardia, pulseless electrical activity and asystole.”("Circulation ," 2005, p. IV-58)Other signs and symptoms that could occur prior to sudden cardiac arrest, include fatigue,

Trauma, or unintentional (accidental) injuries, is the leading cause of death in individuals in the age groups 1-44 and is the fifth leading cause of mortality in the United states (Heron,2010). The major cause of preventable deaths from these traumas was caused by uncontrollable hemorrhaging (Alam, 2009). If doctors had more time to evaluate and repair the damage, they could prevent deaths caused by uncontrolled hemorrhaging. A new clinical trial using induced hypothermia is being conducted by Samuel A. Tisherman at the University of Pittsburg Medical Center (UMPC) Presbyterian Hospital to enable surgeons to fix the structural damage that would otherwise be fatal. This revolutionary procedure is called

Over the last two years, I have had the opportunity of working with astounding physicians providing quality patient care. Through my observations, I have come to understand a doctor has the privilege of sharing someone’s best, worst, and most private moments. I hope to someday have the honor of becoming a physician to care for patients in these moments with the intent of improving the patient’s quality of life as well as preserving their physical and mental well-being. Sometimes patients are seen only as a list of symptoms, a diagnosis, or plan of treatment. However, a patient is so much more; he or she is a human being that should be evaluated and treated as an individual who only wants to get