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Therapeutic Hypothermia For Cardiac Arrest Patients: Improving Patient Outcome
Story Number is : 030809134
PROVIDED
MediSys Health Network

Cardiac arrest is a medical condition that requires immediate care. While it can be fatal, CPR and defibrillation can restore an individual’s heartbeat and increase their chances of recovery. Still, those successfully resuscitated often suffer some degree of brain injury which can lead to severe disability or death. In an effort to improve the neurological outcomes of resuscitated patients, the MediSys Health Network is participating in a FDNY initiative called “NYC Project Hypothermia.”

As part of the project, Brookdale, Flushing, and Jamaica Hospital Medical Centers—which make up the MediSys Health Network—will follow protocol to induce hypothermia (lower body temperature) in patients who survive cardiac arrest and show evidence of brain injury.

“When a person is in cardiac arrest, not only do they lose heart function during that time, but they lose blood to their brain as well,” explained Dr. Lewis Marshall, Chairman of Emergency Medicine at Brookdale Hospital. “The purpose of cooling these patients is to help maintain their brain function.”

“In essence, cooling places the brain in “hibernation.” It slows down brain function and decreases the brain’s need for oxygen. This gives the brain a chance to recover,” added Dr. Geoffrey Doughlin, Chairman of Emergency Medicine at Jamaica Hospital.

Therapeutic hypothermia involves three phases:
• Cooling phase. Hypothermia is induced within 4 hours of patient’s arrival in the emergency room. There are a variety of cooling techniques, either external or internal, that are used in combination with chilled intravenous fluids for inducing hypothermia. Examples of cooling techniques include ice packs, cooling mattresses, cooling catheters, and ice cold IV saline.
• Maintenance phase. Once cooled to between 32-33 C, patients are maintained in a hypothermic state and closely monitored for 24 hours. During this time, physicians watch for and treat potential complications, such as shivering.
• Re-warming phase. Over the next 16 hours patients are slowly re-warmed to 37 C, normal body temperature.

Throughout the cooling process, patients are also administered all other post arrest treatments.

While the therapy has proven to be very beneficial, not all cardiac arrest patients meet the criteria for therapeutic hypothermia. Patients must be successfully resuscitated within 30 minutes after their arrest and should present evidence of potential brain malfunction. They must also be older than 18 years old.

“Resuscitating cardiac patients is important, however, our goal with this project is to get patients back to normal functioning,” said Dr. Robert Crupi, Chairman of Emergency Medicine at Flushing Hospital. “There’s good evidence-based medicine demonstrating the benefits of hypothermia in protecting the brain after cardiac arrest.”
Studies, conducted in Melbourne, Australia, established that cooling patients 32-24 C for 12 hours following arrest increased the likelihood of favorable neurological outcome. Several similar studies throughout Europe reported the same findings, adding that cooling patients also decreased mortality. These studies are the basis for the therapeutic protocol being implemented by the hospitals involved NYC Project Hypothermia.
Along with the FDNY, the American Heart Association and the International Liaison Committee on Resuscitation now recommends using therapeutic hypothermia for unconscious patients with spontaneous circulation after cardiac arrest.
MediSys Health Network is the not-for-profit parent organization of the following hospitals— Jamaica Hospital Medical Center, Brookdale University Hospital and Medical Center, Flushing Hospital Medical Center—as well as the Trump Pavilion for Nursing and Rehabilitation, the Schulman Schachne Institute for Nursing and Rehabilitation, the James and Sarah Brady Institute for Traumatic Brain Injury, the Advanced Center for Psychotherapy and a network of 20 neighborhood-based family healthcare centers. The MediSys Health Network has over 8,000 employees and boasts three state designated Stroke Centers, one of only 4 Centers for Bioterriorism Preparedness in New York City, two Level 1 Trauma Centers, and TJH Medical Services, the 8th largest physician group in New York. For additional information, please contact Public Affairs at 719-206-6020.



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