Theraputic hypothermia - new evidence of less benefit then previously thought??

[Christopher]

That's my point. What you guys should be looking at is what the temp of these patient's are AT ROSC. Not when they reach the hospital, but how cool did they actually get before their heart started beating.

We have that info, but have not looked at the number specifically as our transport time is ~15 minutes. Usually it takes no more than 20 minutes to get off scene and to the hospital. If it were longer we'd probably scrutinize the temp at ROSC.

I'll see how easy that is to dig up from emsCharts.

 

[triemal04]

We have that info, but have not looked at the number specifically as our transport time is ~15 minutes. Usually it takes no more than 20 minutes to get off scene and to the hospital. If it were longer we'd probably scrutinize the temp at ROSC.

I'll see how easy that is to dig up from emsCharts.

I'd be very curious to see those numbers. And also, how are you checking the temp? Core temp through an esophageal probe or rectal? Or temporal and tympanic?

I think that any benefit will almost have to come from making it easier to resolve vf; if you break down the numbers, even if TH was started intraarrest you'd only be starting it roughly 20 minutes sooner than in the study. I doubt that would suddenly make a difference UNLESS it helped with ROSC.

But like I said, if there is data that points to that it should be looked at in more depth.

 

[Christopher]

I'd be very curious to see those numbers. And also, how are you checking the temp? Core temp through an esophageal probe or rectal? Or temporal and tympanic?

Temporal ("highest" of 3) and tympanic ("ear tug" technique), rectal was considered but dropped as most of the service area does not have access to this type of thermometer. We've been aware of the possibility of bias given the variability of tympanic (and especially temporal), so we usually check q 5 minutes. The few times we've checked PR vs Tympanic, as long as you're doing the ear tug and the device itself isn't cold or hot, it agrees "well" (+/-0.5C).

Obviously not ideal, one avenue we've been looking at is using an esophageal temp probe when we place an OG tube, but the cost is fairly prohibitive for my smaller service.

I think that any benefit will almost have to come from making it easier to resolve vf; if you break down the numbers, even if TH was started intraarrest you'd only be starting it roughly 20 minutes sooner than in the study. I doubt that would suddenly make a difference UNLESS it helped with ROSC.

Our perceived benefit was two fold:
1. Earlier TH thought to be neuro/cardioprotective.

2. Patients who we work long enough to become "refractory" will dip to cool enough levels to help us break them.

But like I said, if there is data that points to that it should be looked at in more depth.

Agreed.