Introduction to therapeutic hypothermia for cardiopulmonary arrest after admission to the ICU Edward Omron MD, MPH, FCCP Pulmonary and Critical Care Medicine Morgan Hill, CA 95037

1. Mild Therapeutic Resuscitative Hypothermia Edward M. Omron MD, MPH Critical Care Service

9. Physiological Effects of Cooling

12. When a patient is cooled, pCO2, pO2 decrease, and pH increases, measured at the patient’s temperature. At 37ºC in Machine: 7.35 / 45 / 100 At 33ºC in Patient: 7.41 / 40 / 90 Blood Gases and Temperature

14. As you cool the patient, vasoconstriction will decrease effective vascular volume. - Diuresis - Lose potassium - Lose phosphate - Potassium shifts intracellularly As you warm up, patient intravascular space expands, and potassium shifts out of cells Danger of hyperkalemia if you replaced potassium earlier (Abiki 2001; CCM 29: 1726-30; Zeiner 2004; Resuscitation 60: 253-61) Electrolyte and Fluid Shifts

19. Questions?