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" This study found that a simple, external cooling protocol could be implemented easily "overnight in any system already treating post-resuscitation patients" and had an 89% success rate in reaching optimal temperature -- however, only 27 patients made up the study (Busch 2006: 1277).
A more recent, 2009 study by Castren (2009) "Scandinavian clinical practice guidelines for therapeutic hypothermia and post-resuscitation care after cardiac arrest" found the TH technique ineffective because even experienced physicians were unaware of "optimal target temperature, duration of cooling and rewarming time" and were only able "to predict the clinical outcome correctly in only 52% of the patients" (Castren 2009: 280). Supporters of the therapy admit that a lack of knowledge and training has made widespread implementation of TH problematic. In one Canadian study by Kenneday, J. et al. (2010),"The use of induced hypothermia after cardiac arrest: a survey of Canadian emergency physicians," only one half of Canadian physicians were found to have used TH in practice. Poor training rather than ineffectiveness of the technique was blamed.
Controversy regarding the effectiveness of TH in regarding brain injuries is even more controversial. A study by Marion, et al. (1997) "Treatment of Traumatic Brain Injury with moderate hypothermia" of 82 patients concluded, based upon neurological recovery rates of 82 patients with similar injuries that hypothermia may limits metabolic processes that can exacerbate TBI. But a 2010 study of stroke patients by Hemmen, "Intravenous thrombolysis plus hypothermia for acute treatment of ischemic stroke (ICTuS-L)" found little improvement.
Conclusion: Nursing strategy recommendations and importance of using a theoretical model
The larger studies of TH tend to be less conclusive regarding the technique's effectiveness. This should not be surprising, given that, because of the limited available test population, a tightly-controlled experimental study can be difficult to conduct. The absence of comparative longitudinal data and very large population studies of patients with or without TH treatment may also be partially due to a lack of physician training in the technique and thus its lack of implementation. To date, the most sweeping review of the data has been that of Sayre (2010) who found neither help nor harm were conveyed by the therapy's use.
More research is needed upon practitioners who are trained in TH, to establish a direct causation between improved outcomes and TH in cardiac and other patients who have experienced an injury. Rigorous use of empirical study is always required when evaluating the efficacy of medical techniques, given the inevitable idiosyncrasies within populations, instating controls, and applications of that technique.
Busch, M. (2006). Rapid implementation of therapeutic hypothermia in comatose out-of-
hospital cardiac arrest survivors. ACTA Anaethesiol Scandinavica, 50 (10): 1277-1283.
Castren, M. (2009). Scandinavian clinical practice guidelines for therapeutic hypothermia and post-resuscitation care after cardiac arrest. ACTA Anaethesiol Scandinavica, 53 (3): 280-288.
Eisenburger, Philip, et al. (2001). Therapeutic hypothermia after cardiac arrest. Current Opinion in Critical Care, 7: 184-188.
Hemmen, T.M. (2010). Intravenous thrombolysis plus hypothermia for acute treatment of ischemic stroke (ICTuS-L): final results. Stroke.
Hovdenes, J. et al. (2007). Therapeutic hypothermia after out-of-hospital cardiac arrest:
experiences with patients treated with percutaneous coronary intervention and cardiogenic shock. ACTA Anaethesiol Scandinavica, 51:137-142.
Kenneday, J. et al. (2006). The use of induced hypothermia after cardiac arrest: a survey of Canadian emergency physicians. The Journal of the Canadian Association of Emergency
Marion, D. et al. (1997). Treatment of traumatic brain injury with moderate hypothermia.
New England Journal of Medicine, 336(8):540-6.
Oksanen, T. et al. (2007). Therapeutic hypothermia after cardiac arrest: implementation and outcome in Finnish intensive care units. ACTA Anaethesiol Scandinavica, 51 (7):866-
Sayre, M.R. et al. (2010) Effect of pre-hospital therapeutic hypothermia on neurologic outcome following sudden cardiac arrest.…[continue]
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