Development and implementation of a therapeutic hypothermia protocol.
Two randomized controlled trials published in 2002 demonstrated that mild hypothermia induced after resuscitation from cardiac arrest decreased mortality and improved neurologic outcomes. Although therapeutic hypothermia is relatively easy to implement, side effects and special nursing considerations are associated with this therapy. This article discusses the process of developing and implementing a therapeutic hypothermia protocol. Patients resuscitated after cardiac arrest are cooled to 32 degrees C-34 degrees C for 12-24 hrs. Discussion highlights include patient selection, physiologic effects of hypothermia, routes of induction, nursing implications, protocol development and implementation, and review of current literature related to this topic. An established hypothermia protocol, order set, and education program can be successfully implemented in any institution providing standardized care of post-cardiac arrest patients.
Kupchik
Nicole L
NL
Harborview Medical Center, Seattle, WA, USA. nkupchik@u.washington.edu
D001145:Arrhythmias, Cardiac / Q000209:etiology; D002407:Catheterization, Swan-Ganz; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D003428:Cross Infection / Q000209:etiology; D004562:Electrocardiography; D004569:Electroencephalography; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D016857:Hypocapnia / Q000209:etiology; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000451:nursing*; D050316:Medical Order Entry Systems; D008657:Metabolic Clearance Rate; D008991:Monitoring, Physiologic / Q000379:methods / Q000451:nursing; D009730:Nursing Assessment; D010092:Oximetry; D010348:Patient Care Team / Q000458:organization & administration; D018579:Patient Selection; D012768:Shivering / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome; D014861:Washington; D014883:Water-Electrolyte Imbalance / Q000209:etiology