Feature: Beyond the blankets of hypothermia for cardiac arrest
In a recent study, researchers from the University of Pennsylvania School of Medicine in Philadelphia found that the use of cooling blankets upon arrival at the hospital for sudden cardiac arrest patients was cost effective. Cardiovascular Business News asked lead author Raina Merchant, MD, to discuss the topic.
CVB: While you looked at cooling blankets, what are your opinions about IV saline cooling in both the prehospital and hospital settings?
Merchant: Previous work by Bernard and colleagues demonstrated that surface cooling can be augmented with peripheral IV cooling. At our institution, we have adopted this approach and found that we can reach target temperature (34 degrees Celsius) much faster when we give two liters of ice cold saline immediately after return of circulation following cardiac arrest. If ambulances have the capability to keep cold saline onboard, this approach also can be easily implemented in the prehospital setting and continued once patients are brought to the emergency department.
CVB: Why do you think there is resistance among hospitals to adopt hypothermia therapy for cardiac arrest patients and what can be done to increase adoption?
Merchant: The reasons for slow adoption for hypothermia are likely multifactorial. Implementation of this treatment is a paradigm shift for healthcare professionals -- traditionally survival from cardiac arrest is extremely poor regardless of heroic measures. Now we have a therapy that can literally save lives and allow some people to return to their homes/families/jobs with similar mental functioning as in their pre-arrest state. This is an exciting time for a novel therapy to improve survival from cardiac arrest, but it requires people to change their perceptions about the morbidity previously associated with cardiac arrest. It isn't a miracle therapy, but many people are now having good outcomes who previously did not.
Other factors that will increase adoption include: continued support of physician and nurse champions at individual facilities to promote the therapy, widespread dissemination of hypothermia protocols, support of the therapy by hospital administrators, and regulations that will incentivize hospitals to provide life-saving cooling therapy.
CVB: What should our readers know about hypothermia therapy that can help them adopt the practice in their facilities?
Merchant: Therapeutic hypothermia is the only treatment for cardiac arrest survivors that has been shown to improve survival and neurologic outcomes. It is easy to implement and it is cost effective. It is recommended by the American Heart Association (AHA) and considered standard of care. To provide the highest level of quality care, the therapy should be available for all post-arrest patients.
CVB: What is the next step in your research?
Merchant: Next steps will involve continuing to investigate how to make the current therapy even better (i.e., faster ways to cool, better approaches to monitoring cooling) and more widely available for all patients. We also will look more closely at how to best estimate the costs of long-term care associated with patients who survive cardiac arrest with good and poor outcomes.
CVB: While you looked at cooling blankets, what are your opinions about IV saline cooling in both the prehospital and hospital settings?
Merchant: Previous work by Bernard and colleagues demonstrated that surface cooling can be augmented with peripheral IV cooling. At our institution, we have adopted this approach and found that we can reach target temperature (34 degrees Celsius) much faster when we give two liters of ice cold saline immediately after return of circulation following cardiac arrest. If ambulances have the capability to keep cold saline onboard, this approach also can be easily implemented in the prehospital setting and continued once patients are brought to the emergency department.
CVB: Why do you think there is resistance among hospitals to adopt hypothermia therapy for cardiac arrest patients and what can be done to increase adoption?
Merchant: The reasons for slow adoption for hypothermia are likely multifactorial. Implementation of this treatment is a paradigm shift for healthcare professionals -- traditionally survival from cardiac arrest is extremely poor regardless of heroic measures. Now we have a therapy that can literally save lives and allow some people to return to their homes/families/jobs with similar mental functioning as in their pre-arrest state. This is an exciting time for a novel therapy to improve survival from cardiac arrest, but it requires people to change their perceptions about the morbidity previously associated with cardiac arrest. It isn't a miracle therapy, but many people are now having good outcomes who previously did not.
Other factors that will increase adoption include: continued support of physician and nurse champions at individual facilities to promote the therapy, widespread dissemination of hypothermia protocols, support of the therapy by hospital administrators, and regulations that will incentivize hospitals to provide life-saving cooling therapy.
CVB: What should our readers know about hypothermia therapy that can help them adopt the practice in their facilities?
Merchant: Therapeutic hypothermia is the only treatment for cardiac arrest survivors that has been shown to improve survival and neurologic outcomes. It is easy to implement and it is cost effective. It is recommended by the American Heart Association (AHA) and considered standard of care. To provide the highest level of quality care, the therapy should be available for all post-arrest patients.
CVB: What is the next step in your research?
Merchant: Next steps will involve continuing to investigate how to make the current therapy even better (i.e., faster ways to cool, better approaches to monitoring cooling) and more widely available for all patients. We also will look more closely at how to best estimate the costs of long-term care associated with patients who survive cardiac arrest with good and poor outcomes.