THERAPEUTIC HYPOTHERMIA

Therapeutic Hypothermia

Therapeutic Hypothermia

Introduction

The therapeutic hypothermia is the lowering of core body temperature leads to a significant increase in survival and relevant to the quality of survival treated patients due to insufficient blood supply due to ischemic events. Periods of inadequate blood supply to a cardiac arrest, heart attack or blockage of an artery by embolism, as are triggered in the event of a stroke. Heart attacks are responsible for about 325,000 deaths annually in the United States (Heart Rhythm Foundation, 2010). The majority of these cardiac arrests occur outside the hospital setting, with a dismal national survival rate of 8% (American Heart Association, 2010). The Bernard (2002) demonstrated that by initiating therapeutic hypothermia as a treatment modality for cardiac arrests the survival rate could be as high as 49% and 55% respectively. Therapeutic hypothermia can be initiated in many different settings.

Discussion

Cardiac arrest is a condition where the heart starts beating erratically (ventricular fibrillation) or stops beating completely. Collins and Samworth (2008) evaluated the studies about the utilization of therapeutic hypothermia on cardiac arrest patients. The researchers analyzed related studies from numerous databases for the period of 1997- 2007. The researchers found that there were two randomized controlled trials which provided apparent support for the use of therapeutic hypothermia in the treatment of cardiac arrest patients. The researchers suggest further research about the use of in hospital arrest and earlier initiation is needed. The researchers recommend that hospitals should devise therapeutic hypothermia policies/procedures since favorable outcomes from the studies support its use (Collins and Samworth, 2008).

Therapeutic hypothermia and Heart attack

The prognosis of a patient who, after being resuscitated from sudden cardiac arrest outside hospital, comes alive to a hospital depends largely on neurological impairment he has suffered. Unfortunately, once recovered pulse, and a state of persisting neurological impairment, there is no clinical sign that allows unequivocally distinguish those patients who had a good neurological recovery from those who will suffer permanent neurological sequelae due to cerebral anoxia. Booth et al, in a metaanalysis of 11 studies that included 2000 patients, concluded that there was no immediate clinical signs can predict the neurological outcome of these patients. There are documented cases in the early 50's, in which moderate hypothermia was used as a mechanism for neuroprotection after recovery from cardiac arrest.

In 2002, two multicenter clinical trials were published simultaneously, prospective and randomized, comparing mild hypothermia with normothermia in comatose patients after suffering a cardiac arrest outside the hospitals. Inclusion criteria were similar for both: VF or pulse less ventricular tachycardia as the first rhythm analysis, spontaneous recovery of the circulation and persistence of coma after cardiac arrest. Both stops likely excluded noncardiac etiology and patients in cardiogenic shock. 

Types of Therapeutic Hypothermia

Cooling methods in patients

The improved cooling methods are a key point in the renewed interest in this treatment. The ideal cooling technique would be one that would achieve the target temperature quickly that would enable to easily maintain the desired temperature without fluctuations, which is non-invasive and allow a wide margin of safety, avoiding ...