Staying Alive with Ice, Ice Baby

Abstract

In the United States, cardiac arrest is a devastating event that happens to affect approximately 300,000 people annually. There is less than a 10% survival rate and of those survivors an estimate of 50% have serious long term neurological deficits (Grossestreuer, 2013). The American Heart Association (AHA) now has new guidelines recommending the use of therapeutic hypothermia in cardiac arrest patients.

Method: The question arises – In the patients after cardiac arrest who have a return of spontaneous circulation (ROSC), does inducing therapeutic hypothermia compared to maintaining normothermia improve patient outcomes? More specifically, how should this new guideline from the AHA be implemented into practice? In order to determine the outcomes, a systematic review of the literature was performed.

Results: Throughout the articles analyzed, the data indicates that there are greater survival rates among cardiac arrest patients after ROSC with an average confidence interval (CI) 95%. Using the cerebral performance category (CPC) scale, favorable neurological outcomes is defined as a CPC score of 1 or 2. Articles results indicate that induced hypothermic patients had an overall greater likelihood of having this favorable neurological outcome.

Conclusion: The AHA is correct in recommending this as a new guideline for cardiac arrest patients during resuscitation. Induced therapeutic hypothermia has proven to be effective in improving patient outcomes and many hospitals have implemented and created their own protocols.

Recommendations: In order to improve patient outcomes, a standard of selection criteria needs to be created in order to better identify patients that are appropriate for this treatment. Because of the tremendous improvement in patient outcomes related to cardiac arrest patients, therapeutic hypothermia research should include other patient populations such as stroke.

Keywords: cardiac arrest, therapeutic hypothermia, AHA

Grossestreuer, A. V., Abella, B. S., Leary, M., Perman, S. M., Fuchs, B. D., Kolansky, D. M., … Gaieski, D. F. (2013). Time to awakening and neurologic outcome in therapeutic hypothermia-treated cardiac arrest patients. Resuscitation 84 (2013) 1741-1746.