# Pre-Hospital Hypothermia Induction for Post Cardiac Arrest



## SCFlightMedic (Aug 19, 2007)

Hello!

Does anyone know of any EMS services in the United States that are doing pre-hospital hypothermia induction for post-cardiac arrest resuscitation? I am only familiar with three, Regional One Air Medical in Spartanburg, South Carolina, Seattle Fire Department/King County Medic One and Wake County EMS in Raleigh North Carolina. Does anyone know of other services that are using this protocol?

On a second note, does anyone know of hospitals in their area that use this protocol?

Thanks!
Mike


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## Ridryder911 (Aug 19, 2007)

We have been discussing such on another EMS forum, hopefully it is okay to link it. Possibly, we could discuss it more here.
http://fieldmedics.com/forum/viewtopic.php?t=2060&start=0

Personally, I am not aware of anywhere that is using prehospital other than were we discussing it in Florida and I have heard of WA, and possibility of AZ.  

Just a few days ago, a local television reported that they are using induced hypothermia on cardiac patients and cardiac arrest. Appearantly, they have been testing this in one of the hospitals near me for several years with + benefits. It has been widely published and now are attempting to introduce the methodology. For more reading and results. 
http://www.aacnclinicalissues.com/p...ZDNBpf9NZMnDdrXg!-362743511!181195628!8091!-1

R/r 911


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## Flight-LP (Aug 19, 2007)

Cypress Creek EMS, Houston, Tx....................

started several Months ago..........


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## SCFlightMedic (Aug 19, 2007)

Thanks for the replies!  That is good to know that Cyprus Creek is now doing it!  I assure you, you have joined a very limited group of EMS agencies in the United States!  I work at a helicopter service in South Carolina that was actually the first service pre-hospital to implement the protocol (we started July, 2005).  Since that time, our Program Director at the helicopter and myself have gone around the world teaching about hypothermia induction, our protocol and our results.  Throughout our lecturing, we have encountered less than five pre-hospital agencies who are implementing the protocol.  Do you have to transport to a specific hospital in Houston, or all of the hospitals there doing the protocol?  If you don't mind would you be able to send me a copy of your protocol?  I'd love to see how you are doing it!

RR, I see you are both a RN and EMT-P.  Are you using the protocol anywhere in hospital?

My colleague and I have an educational grant to teach about hypothermia induction, and to assist EMS agencies with protocol implementation in the United States (free of charge!) if you are interested, or know of anyone who is.  

Thanks again!
Mike


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## Ridryder911 (Aug 19, 2007)

I believe they are using induced hypothermia in the hospital setting at the Oklahoma University and possibly at the Oklahoma Heart Hospital. I tried finding the news video describing the cooling device. It was similar to surgical coolers, that looks like blood pressure cuffs that is pumped with coolent, I presume saline. Their protocol is to maintain core temp at 90 F. 

What are device and how are you maintaining hypthermia, as well what is your goal and monitoring system? When do they re-warm?

R/r 911


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## MedicPrincess (Aug 19, 2007)

I believe I heard some services in South Florida are using it.

Also, one of our 3 level 2 trauma centers that we frequently fly patients to has started doing this.  They are also inducing hypothermia in CVA patients as well.


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## Alexakat (Aug 19, 2007)

Our hospital recently developed an induced hypothermia post-cardiac arrest protocol.  We're in Southeastern Virginia...

None of our EMS agencies have yet, to my knowledge, though...


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## Ridryder911 (Aug 19, 2007)

This has been studied for years in Japan, but the U.S. has so many restrictions on studies, it has taken a while to attempt in here. 

R/r 911


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## VentMedic (Aug 20, 2007)

We've been using hypothermia protocols in the hospital on and off for about 5 years. This is after using it for a brief period over 20 years ago in the hospital and a weak attempt pre-hospital in the mid 1980s (Florida). As they say what is old is new again. 

The biggest issue for EMS is the use of paralytics to prevent shivering for the protocol.  

We had a recent thread here but the same person started a more extensive thread with some good info at:
http://www.emtcity.com/phpBB2/viewtopic.php?t=9121&postdays=0&postorder=asc&highlight=rosc&start=0

Not all hospitals are finding it worthwhile as well as costly even though some of the local EMS are wanting to do the pre-hospital cooled saline protocol.  I have not seen a lot of good outcomes in the hospital where the hypothermia made a difference and it is a LONG 24 hours to manage a patient on the protocol as well as the rewarming phase.  The 12 hour shift spent at the patient's bedside can be exhausting chasing temps, numbers and just prolonging the inevitable in most cases. Not all patients tolerate the hypothermia well.  Our cases have been from initiating the protocol in the ED and inhouse codes. There is a delay of a few minutes after pulses/stability return because doctors want to determine some neural status and viability before committing to the protocol. Once the paralytic is initiated, that's it for the duration.

I know that there have been some very well published data of "good" results. However, not everybody wants to write about their "bad" results. Keep that in mind when reading the data. For each success, there may have been 10 non-successes that got excluded for "technical" reasons.  Some of the studies have also been sponsored by the manufactures of the equipment that Rid mentioned, which is extremely expensive even for hospital costs. Yes, the impartial and objective world of research.


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## VentMedic (Aug 21, 2007)

Massachusetts General Hospital has a condensed version of a hospital hypothermia protocol as well as some other research projects online:
http://www.massgeneral.org/stopstroke/protocolHypothermia.aspx


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