Thursday, December 4, 2008

Ice Ice Baby

When the American Heart Association changed the CPR guidelines in 2005, they recommended cooling victims of cardiac arrest to 32-34˚C for 12-24 hours in an effort to limit brain damage due to oxygen deprivation.  Anecdotally at least, it appears that this policy has been slow to catch on, as we currently do not cool cardiac arrest patients in our ED, and neither do any of the several ambulance services that feed into us.

That may all begin to change, as a front page article from the New York Times this morning reports that starting January 1st, ambulances in New York City will bypass closer hospitals to deliver patients in cardiac arrest to EDs with cooling therapy.  The article cites some impressive statistics, namely that 55% of patients who were cooled down experienced moderate or no brain damage, compared to 39% who received normal treatment.

I'll be interested to see how outcomes differ after this policy goes into effect, and whether it will change the prevailing view that simply getting to any ED as quickly as possible is of primary importance and become a new standard of care.  In the meantime, however, it might be wise to start throwing some saline bags into the freezer.

UPDATE: The Chicago Tribune reports on a "Slurpee" method of cooling patients... maybe we won't need the saline after all.

5 comments:

Anonymous said...

We cool patients that arrest in-house. If somebody has a cardiac arrest in house and they survive the code, we'll cool them in the ICU with a device known as the Arctic Sun. We've had good results so far, although the sample size isn't enormous.

Who'd-a thunk it?

Second Shift said...

Sounds pretty cool. I'm assuming these things will become pretty standard in the future (we already have Bear Huggers to warm people up). Now if only I can get one for when the air conditioning breaks down...

Anonymous said...

As it happens I was watching a show about DARPA last night, and they have a device that can cool core temperature quickly by cooling peripheral blood through the hands...sort of a glove with a metal rod in it that acts as a heat sink. Anyway it's something I can see making this sort of therapy much faster and more effective.

xtine said...

An EMS friend was telling me about this a month or two ago.

Apparently, in a county here in NC, that's standard protocol. His words were something like 'If you have a heart attack in [our] county, you have incredible odds, but we're sticking what is essentially an ice dildo up your ass. Seriously, this is one of the best places in the nation to have a heart attack, unless you're out near the county lines'
(Those county lines can be over an hour away from the central part of the county).

I'm sending your article to him :-D

Second Shift said...

I'll be choosing the heat sink glove over Xtine's option, but I saw an info card from Arctic Sun at work today, so I guess that means we'll be getting those soon. Looking forward to seeing it used during a code.