HYPOTHERMIA POST VF ARREST by kby12992

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									HYPOTHERMIA POST VF ARREST

CAEP GUIDELINE
Hypothermia post arrest
Studies looked at VF/VT
Application to other rhythms unknown
but may be considered


INCLUSION
Primary cardiac arrhythmia
Collapse to ACLS < 15 min
Collapse to ROSC < 60 min
Persistent GCS < 10
Age > 18yo

EXCLUSION
Improving neuro status
Coma due to non-cardiac cause
Arrest due to non-cardiac cause
Persistent hypoxia < 85% X 15 min
Hypotensive despite vasopressors
        SBP < 90 X 30 min
        MAP < 60 X 30 min
Coagulopathy
Terminal illness

GENERAL GOALS
MAP > 75 (pressors prn)
Sats > 98%
Do baseline neuro exam
Discuss hypothermia with ICU
Sedation
         Midaz 0.04-0.2 mg/kg/hr
         Propofol: 10 - 80 ug/kg/min
         Fentanyl 0.7-10 ug/kg/hr
Paralysis
         Roc: 0.6-1.0 mg/kg q1hr
         Pancuronium: 0.1 mg/kg q2hr

COOLING GOALS
Target temp 32-34 w/I 2-6 hrs
Ice packs to head, neck, axillae, groins
Wet sheet and fan
Cooling blanket
AUSTRALIAN STUDY
Bernard. NEJM FEB 2002
RCT, N=77
Included: VF rhythm, ROSC, coma after ROSC
Excluded: <18, <50yo female, SBP despite epi, non-cardiac cause of arrest
33 degrees X 18 hours (? active warming in the non-hypothermic group)
Outcome was survival to discharge or neurorehab unit
Good neuro outcome (home or rehab)
         49% vs 26% p=.04
         ARR= 23% NNT=4.3
         OR 5.25 (1.5-18.7)
No diff in complications


AUSTRIAN STUDY
NEJM FEB 2002
RCT, N=136
Included: witnessed arrest, initial VF/VT, EMS arrival < 15 min, ROSC < 60 min
Excluded: hypothermic on admission, pregnant, responds to verbal after ROSC, hypotension > 30
min after ROSC, sats < 85% >15 min after ROSC, ternminal illness, coagulopathy
32-34 degrees X 24 hrs
Outcome = good neuro outcome at 6 mo
(assessed by validated neuro scale)
         55% vs 39%
         ARR 16%, NNT=6.25
         RR 1.40 (1.1-1.8)
Outcome -= mortality at 6 mo
         41% vs 55%
         ARR 14%, NNT = 7
No diff in complications

								
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