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2011-01-06

Induced hypothermia saves lives at Christus Santa Rosa

Contributed

To help save lives of individuals with cardiac arrest, the Intensive Care Unit staff at Christus Santa Rosa Hospital-New Braunfels is utilizing a technique on certain patients that markedly lowers the body temperature, which preserves critical brain functions.
The procedure, called induced hypothermia, can be used to treat cardiac arrest patients whose conditions, based on a variety of factors, is likely to be reversible.
Through proper identification of potential patients and by following strict guidelines, several victims of cardiac arrest have experienced a complete recovery upon arriving at Christus Santa Rosa Hospital-New Braunfels without a heartbeat.
Three years ago, Mary Ann Holland, RN and education coordinator at the hospital, and Dr. Steven Slagle wrote a protocol for induced hypothermia. This protocol served as a resource for the current protocol that has since been incorporated throughout Christus Santa Rosa Health System.
"By inducing hypothermia, we are attempting to protect the patient's brain due to lack of oxygen during a cardiac arrest event such as heart attack, choking, drowning or electrocution. To meet the criteria for induced hypothermia, the patient must experience a short period of time without a heartbeat. CPR is essential until the heartbeat is restored. The procedure cannot be performed on patients experiencing traumatic and active bleeding, dementia and chronic renal failure or those under a do not resuscitate order," said Holland.
To maximize the effectiveness of the procedure, Holland and Slagle worked closely with New Braunfels EMS Director Dr. John Flanagan to ensure that the protocol can be administered to cardiac arrest patients in the field. Prior to arrival at the hospital, EMS personnel can administer cold fluid intravenously and apply cold packs to immediately facilitate cooling.
After being transported to Christus Santa Rosa Hospital-New Braunfels Emergency Department, the patient is placed on a bed and wrapped in a hypothermia blanket that circulates cold water. The patient's core body temperature is dropped to 90ยบ F and constantly monitored for a period of 24 hours.
During this time, the patient is kept on a ventilator because a paralytic agent is frequently required to keep the patient from shivering - the body's natural reaction to decreased body temperature. Sedation medication is also delivered to ensure that the patient remains sedated during the 24 hours of cold therapy.
"In addition to temperature, we monitor a host of functions during the induced hypothermia process, including blood pressure and a special monitor to ensure appropriate sedation," Holland said.
Once the hypothermia administration is complete, the body is slowly re-warmed at a rate of one degree every two hours. The paralytic and sedation medication is decreased.
"While the induced hypothermia technique is the best hope at present to help with brain recovery, it should be noted that a significant number of patients remain unresponsive after completion of treatment. Patients who achieve a meaningful recovery represent a small percentage of the total number of cardiac arrest patients," she said.
In successful cases, as the patient awakens and becomes responsive to simple commands, the ventilator is no longer needed. Those patients who experience a complete recovery usually remember little if anything about their cardiac arrest event.
"Once the patient has successfully completed hypothermia treatment, we initiate the supportive care process.
Specifically, we evaluate and monitor vital organs such as the brain, liver, and kidneys that might have been negatively affected due to oxygen depletion," Holland added.
Jim Wesson, vice president and administrator of Christus Santa Rosa Hospital-New Braunfels commented, "The ability to perform hypothermia protocol treatment to cardiac arrest patients in our region is instrumental in saving lives.
With the prevalence of water sports in Central Texas, we have the opportunity to treat certain incidences of drowning with our hypothermia protocol."
Wesson continued, "We are fortunate to have successful recoveries and will continue to update our procedures as additional best practices for post-cardiac arrest hypothermia become available.