# "I.C.E."  indusing hypothermia in the field



## ffemt924 (Mar 18, 2008)

ever heard of indusing hypothermia in the field? well its true i work for a ems service who uses I.C.E. for ROSC.


----------



## colafdp (Mar 19, 2008)

I've read something about it in a JEMS one day...but i don't remember the specifics or anything. I'd like to know more about it, as it seems like it could be promising.


----------



## katgrl2003 (Mar 19, 2008)

It's in our protocols for the first time this year.  If the pt was in cardiac arrest, but we get pulse and respiration back, we infuse 2L of iced saline.  The patient has to be still comatose, and the arrest can't be the result of hypothermia.

-Kat


----------



## Niftymedic911 (Mar 19, 2008)

We've got the protocol, training, and logistics behind it.  All we're waiting on is the hospital to get on board with our induced hypothermia protocol and we're set.

I've seen it work first hand.  Person arrested in a lobby of a store.  Asyst worked for 30+ min called in the field.  15+ min later came back with ROSC and respirations.  Core temp was 95.3.  He walked out approx 2 months later of the hospital.  After investigation, it was found that due to the polished conrete floor being approx 61 degrees F and the air inside 65 degrees F after being down approx 45 min his temp was low enough, that the blood supply reamined slowed but consistent.  Patient suffered very very little neuro damage.  To the point this person will live a normal life.

Weirdest call ever.


----------



## JPINFV (Mar 19, 2008)

colafdp said:


> I've read something about it in a JEMS one day...but i don't remember the specifics or anything. I'd like to know more about it, as it seems like it could be promising.



The concept is essentially to cool a patient to halt additional damage due to hypoxia. Essentially, hypoxic cells die in one of two manners. Either they die quickly due to necrosis (irreversible) or they die a more ordered and regulated method via apoptosis (can be stopped). The two manners of cell death are completely different and shouldn't be confused. When cellular processes are slowed due to a decrease in temperature, the time it takes for a cell to die via apoptosis is lengthened. Thus, if conditions are changed, it is possible to stop apoptosis preserving additional cells.


----------



## SeeNoMore (Jun 4, 2010)

So help me out with this because no one can give me a straight answer, and no literature I have found seems to answer it. Would this add new importance to cardiac drugs? I know the AHA is getting ready to heavily deemphazie their use and many studies as recent as 2010 seem to basically indicate they are useless. This seems to be because the mere return of a pulse is not the same as survival. However, does ROSC become that much more important with PHypothermia? Or are we better off just getting what pulses back we can without drugs and then cooling patients.


----------



## redcrossemt (Jun 5, 2010)

SeeNoMore said:


> So help me out with this because no one can give me a straight answer, and no literature I have found seems to answer it. Would this add new importance to cardiac drugs? I know the AHA is getting ready to heavily deemphazie their use and many studies as recent as 2010 seem to basically indicate they are useless. This seems to be because the mere return of a pulse is not the same as survival. However, does ROSC become that much more important with PHypothermia? Or are we better off just getting what pulses back we can without drugs and then cooling patients.



Not sure there's any GOOD evidence that says drugs increase ROSC at all. If you think about it, medications are linked to arrests with longer downtimes. Witnessed arrests typically respond to defibrillation alone, if anything at all. That being said, if you can get ROSC (which is much more likely via defib after a witnessed arrest or a short downtime), it is important to protect the body using induced hypothermia. The patients who do need medications have typically already suffered extended downtimes and neurological damage which cooling won't help with.


----------



## SeeNoMore (Jun 8, 2010)

http://medicscribe.com/2010/01/acls-drugs-the-verdict/

This and other articles, which actually are against the drugs, do seem to indicate an increase in ROSC, not sure if it qualifies as good evidence. I suspect that you are correct about the poor outcomes in patients who need more than defibliration, but I also believe prehospital hypothermia has been linked to good outcomes in patients with moderate down times. Ill have to look it up again.


----------



## 8jimi8 (Jun 8, 2010)

it has been used with success in stroke patients as well.  There is still a chance of arrthymia and arrest during the rewarming process as well.

What is your protocol for implementing hypothermia?  Which patients are candidates?


----------



## DaniGrrl (Jun 8, 2010)

Here's the link to the Wake County (where I live) protocols: http://www.wakeems.com/ICE/ihv11.13.pdf


----------



## 8jimi8 (Jun 8, 2010)

DaniGrrl said:


> Here's the link to the Wake County (where I live) protocols: http://www.wakeems.com/ICE/ihv11.13.pdf



Thank you,

could i bug you to post the post resuscitation as well?


----------



## DaniGrrl (Jun 8, 2010)

This?
http://www.med.upenn.edu/resuscitation/hypothermia/documents/WakeMed.pdf


----------



## 8jimi8 (Jun 8, 2010)

Perfect, thanks


----------



## mycrofft (Jun 8, 2010)

*I see protocols and no science.*

Hand me the Binford 700 Mega Whatsis and don't give me the manual....same deal.
Wonder if this process can be safely carried out by field folks in a useful timeframe? Or something like this is what is needed to buy time coming in from "out in the sticks"?
Seriously, a competing approach is being marketed using hydrogen sulphide.


----------



## 8jimi8 (Jun 8, 2010)

San Antonio area hospitals are using the arctic sun; protocols are still being written for the service where I volunteer


----------



## FLEMTP (Jun 8, 2010)

mycrofft said:


> Hand me the Binford 700 Mega Whatsis and don't give me the manual....same deal.
> Wonder if this process can be safely carried out by field folks in a useful timeframe? Or something like this is what is needed to buy time coming in from "out in the sticks"?
> Seriously, a competing approach is being marketed using hydrogen sulphide.




At the agency I work for.. its very easy and very quick. After you get ROSC, and they remain comatose, you call an ICE alert, and change your Normal Saline to the refrigerated NS we carry, and they want us to infuse both liters prior to arrival in the ER, but sometimes that doesn't happen. Last I knew we only had 2 or 3 facilities in the county that could accept the "ICE" alert patients, because the others dont continue the protocol upon arrival in the ER. 

In fact this discussion reminds me that I need to re-read the guidelines we have on the ICE alert. Would do me good to brush up.


----------



## SeeNoMore (Jun 9, 2010)

It's a really cool idea, I hope I work in a service using it as a medic. It's too bad it does not equal our drugs being more useful.


----------



## CAOX3 (Jun 9, 2010)

SeeNoMore said:


> It's a really cool idea, I hope I work in a service using it as a medic. It's too bad it does not equal our drugs being more useful.



Its actually a really cold idea.


----------



## DaniGrrl (Jun 9, 2010)

8jimi8 said:


> Perfect, thanks



Happy to help.


I find the whole concept incredibly interesting. This morning I saw these articles about the progarm in Richmond, VA and thought you guys might be interested:
http://tinyurl.com/2dtmnpz
http://tinyurl.com/2cbrw6a




> The VCU and RAA initiative, known as the Advanced Resuscitation Cooling Therapeutics and Intensive Care Center, or ARCTIC, is the most comprehensive program of its kind in the United States, and its strategy resulted in an almost two-fold improvement in the return of spontaneous circulation, from 25 percent in 2001 using conventional treatments to 46 percent in 2008. In turn, the survival rate to hospital discharge improved from 9.7 percent in 2003 to 17.9 percent at the end of 2008. The national average is less than 7 percent.


----------



## mycrofft (Jun 9, 2010)

*Science, science, science..........*

Just the other week someone in TX posted their protocols for chlorine gas treatment with a nebulizer; the protocol is a well-written part of a very well-done website containing obviously professionally written protocols, but investigation with the USAMRIID revelas that the treatment is largely placebo. No science, impressive presentation and rush to treatment but no science.

This approach is potentially extremely useful in some cases, but useless without a system to support it. Like freezing heads so future people can wake them up.

Someone also commented, that they would rather be on the cutting edge helpng patients than dwelling on the past. Good. But make sure what you are doing actually helps. The medical world is littered with stuff either misunderstood on inauguration, or discredited later without adequate reason for medicolegal issues.

(reference: claims from reputible sources on national media of cure for juvenile diabetes in the US in 2003, and French claims on two occasions they had a vaccine for AIDS).


----------



## jjesusfreak01 (Jun 9, 2010)

8jimi8 said:


> Thank you,
> 
> could i bug you to post the post resuscitation as well?



http://www.wakegov.com/ems/medical/emsprotocols.htm

Link on the right side of the page, it will be pages 126 and 127 (induced hypothermia protocol) in the PDF. These are my local protocols and (although I am still in my EMT class) I should be getting to know these better.


----------

