Therapeutic hypothermia, or induced hypothermia, involves deliberately cooling cardiac arrest patients to between 32-34°C for 12-24 hours after return of spontaneous circulation (ROSC) to reduce reperfusion injury to organs like the brain, heart, liver and kidneys from hypoperfusion and ischemia during the cardiac arrest. It aims to improve outcomes by reducing the effects of post-cardiac arrest syndrome, which involves a complex pathophysiological cascade following ischemia. Current research shows benefits of inducing therapeutic hypothermia before or during the cardiac arrest event. Key aspects of care involve induction of hypothermia within 6 hours, preferably 2 hours, of ROSC, maintenance of target temperature for 12-24 hours,

1. Post Resuscitation Care By Kane Guthrie

2. Objectives Case study Understand post-resuscitation care Look at therapeutic hypothermia

3. Cardiac Arrest the Stat’s Generally 6-7% survival rate (worldwide) 0nly 3-4% leave hospital with RONF Early Defib/compressions make the difference Post resuscitation care is the answer to improving mortality and morbidity with ROSC.

4. The New Guidelines!!

5. Case Study 68 male walking home from pub Collapse > Cardiac Arrest >Bystander CPR SJA arrive 13mins post arrest In VF, Successful ROSC post x3 defibs Arrives in T2 20 mins later with no RONF What should we do now?

6. Post Resuscitation Care What is it? Where does it start? Why is it done poorly? What is Post Cardiac Arrest Syndrome? What is Therapeutic Hypothermia?

7. Post Cardiac Arrest Syndrome!! Thought to be RT production of free radicals Pathophysiology is very complex = BORING Hypoperfusion & Ischaemia cause cascade of events

8. The Big 4 in Postcardiac Arrest Syndrome

9. Therapeutic Hypothermia ‘Induced hypothermia” is were pt is deliberately cooled between 32-33.9°C It aims to reduce hypoperfusion (& reperfusion) injury post arrest. Focuses mainly on brain (neuroprotection), but offers protection to heart, liver, kidneys. Current research shows benefit of inducing TH before or during event.

10. Therapeutic Hypothermia Therapeutic hypothermia is the first treatment that has proven effective for post-resuscitation reperfusion injury. NNT 1:6 vs 1:42 for aspirin in STEMI

11. Who’s up for it? Cardiac arrest with ROSC Persistent significant altered level of consciousness <12 hours from time of ROSC Patients >18 years

12. Who’s on the Fence? Relative: Persistent hypotension (MAP <60, SBP<90) despite use of inotropes and vasoconstrictors Note: Hypothermia will cause vasoconstriction And help ∧BP

13. Who’s not? Advanced directive stipulating DNR (absolute) Traumatic arrest Active bleeding (including intracranial) Pregnancy, recent major surgery, severe sepsis

14. What are the 3 Phase’s of TH? Induction Aim reduce core temp 32-34°C (within 6 hours, preferably 2 hours) Maintenance Maintain core body temp for 12-24 Rewarming Either controlled or passive rewarming to normothermia 37°C 0.2-0.5°C per hour –over 8-12 hours

15. ED Management

17. Monitor skin integrityMachine (Vest, Artic Ice)

18. What you need Patient airway secured (sedated & paralyzed) ICE and bags Cold saline 12 lead ECG Artline NGT IDC Rectal probe ?CVC

20. Remember the basics Pressure area care VTE prophylaxis Stress ulcer prophylaxis Lung protective ventilation Nutrition Social support (family)

21. Complications Tachycardia > bradycardia Hypertension Diuresis (hypovolaemia) Shivering (increases temp) Arrhythmia's Increase bleeding Spiking temp’s look for signs of infection

22. Questions

23. Thank-You