Practical implementation of therapeutic hypothermia after cardiac arrest.
BACKGROUND
Survival after out-of-hospital cardiac arrest (OHCA) remains unacceptably low. Therapeutic hypothermia (TH) is the most efficacious treatment option available for comatose survivors of cardiac arrest. However, clearly delineated instructions for how to induce, maintain, and conclude TH have not been published in a codified format.


OBJECTIVE
We assembled 11 clinicians from the University of Pennsylvania Schools of Medicine and Nursing for a day-long moderated discussion to review our institution's TH protocol and reach consensus on a step-by-step management plan of the comatose survivor of OHCA. We attempted to systematically work our way through the existing University of Pennsylvania TH protocol. The goal was to address critical decisions at each stage of care of the post-arrest patient, including whom to cool, how to cool, how long to cool, how to rewarm, neuroprognostication, and other fundamental aspects of patient management. We made every effort to include relevant scientific evidence with appropriate citations. However, given the paucity of data in certain areas, we have relied heavily on expert opinion.


CONCLUSIONS
We present a step-by-step management plan for incorporation of TH in the care of the comatose survivor of OHCA, which can be adapted to a variety of clinical settings with diverse resources. This article is intended to supplement current care provided by health care providers and should be adopted in concert with current standards of post-arrest and intensive care unit care.
Gaieski
David F
DF
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Ground Ravdin, Philadelphia, PA19104, USA. gaieskid@uphs.upenn.edu
Fuchs
Barry
B
Carr
Brendan G
BG
Merchant
Raina
R
Kolansky
Daniel M
DM
Abella
Benjamin S
BS
Becker
Lance B
LB
Maguire
Cheryl
C
Whitehawk
Michael
M
Levine
Joshua
J
Goyal
Munish
M
D002983:Clinical Competence; D002985:Clinical Protocols; D003128:Coma / Q000628:therapy*; D019091:Critical Pathways / Q000458:organization & administration*; D005260:Female; D006284:Health Plan Implementation; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D017694:Rewarming / Q000379:methods*