PROTOCOL FOR I INDUCING HYPOTHERMIA IN POST CARDIAC ARREST PATIENTS

Induction of hypothermia in the immediate period following a cardiac arrest in patients who have
successfully recovered sinus rhythm but are still comatose has been shown to significantly improve
neurological outcome. It should be considered in any patient who has been brought to the ICU on a
Code Blue and who is unresponsive. Inclusion and exclusion criteria are to serve as a guide for
decision-making.
Passive Convective Cooling
1. Expose the patient, dampen skin, cooling fan
2. Apply soaking wet bedsheet.
3. Continue resuscitation with cold saline (kept at all times in the ICU refrigerator)
4. Reduce temperature in the patients room
5. Ice packs applied to axilla / skin
6. Naso-Gastric lavage with ice cold 0.9% Normal Saline repeat as needed
Medication
1. Propofol 25-50 micrograms per kilogram per minute continuous intravenous infusion while
receiving chemical paralysis (suggested initial rate: 5 micrograms per kilogram per minute)
2. Midazolam 5 mg/ hour may chosen as an alternative.
3. Vecuronium Bolus: 0.1 milligrams per kilogram intravenous bolus followed by Continuous
Infusion- Start continuous infusion 20-40 minutes after initial bolus dose at 1 microgram per kilogram
per minute
4.Norepinephrine IV-start at 0.5 micrograms per minute and titrate as needed to keep MAP greater
than 65
Inclusion Criteria: (requires all four components)
1. Nontraumatic cardiac arrest with return of spontaneous circulation (ROSC)
2. Core Temperature greater than 34 Celsius (94 F) at presentation.
3. Time to initiation of hypothermia is less than 6 hours from ROSC
4. Comatose after ROSC: GCS less than 8 and No purposeful movement to pain
Exclusion Criteria: (any one of the following)
1. Patients who are terminally ill (for instance disseminated malignancies)
2. Uncontrolled Gastrointestinal Bleeding
3. Patient requiring Mannitol therapy
4. Cardiovascular instability as evidenced by: uncontrollable arrhythmias, refractory hypotension
(unable to achieve target MAP 65 mmHg despite interventions)
5. Sepsis as suspected cause of cardiac arrest
6. Suspected intracranial hemorrhage
7. Major intracranial, intrathoracic, or intraabdominal surgery within 14 days
8. Pregnancy Labs: 1. Labs to be drawn Stat:
2.Complete Blood Count (CBC), PT/PTT, INR ABGs (temp corrected)
3.Complete metabolic profile
4.Creatine phosphokinase (CPK), Troponin I, Creatine Kinase Myocardial Bands (CK- MB)
5.Progressive Urinalysis
6.Lactate Labs to be drawn every 6 hours x 24 hours: CMP, ABGs ,CBC, PT/PTT Labs to be drawn
12 hours post arrest:
2.Blood cultures X 2 Daily Diagnostic Testing:
2. CBC
3.ABGs
4.Portable CXR (while intubated)
5.EKG

Procedure:
2.Before inducing hypothermia insert a nasopharyngeal temperature probe available with each
monitor. Set the temperature measurement to degrees centigrade.
3.Using the above mentioned techniques of cooling, achieve a core body temp of 32-34C
4.Do not overcool the patient
5.Maintain hypothermia for 12-24 hrs
6.Allow passive rewarming after 24 hrs
7.Paralysis is generally stopped after achieving body temp>36C to avoid shivering and discomfort to
the patient