Therapeutic hypothermia: clinical applications and outcomes review

Therapeutic Hypothermia Review

Annotated Bibliography

Lucero, Catherine (2010) Therapeutic Hypothermia. Clinical Correlations. Retrieved from: http://www.clinicalcorrelations.org/?p=2032

Lucero (2010) writes of therapeutic hypothermia "resumption of spontaneous circulation after prolonged ischemia due to cardiac arrest carries significant morbidity and mortality and much effort has been directed toward reducing the debilitating consequences." Lucero reviews the studies that demonstrate an association between therapeutic hypothermia in post-cardiac arrest patients and improved neurological outcomes.

Tran, Bau P., et al. (2010) Use of Mild Therapeutic Hypothermia to Treat Cardiac Arrest. Journal of the American Academy of Physician Assistants. 1 Mar 2010. Retrieved from: http://www.jaapa.com/use-of-mild-therapeutic-hypothermia-to-treat-cardiac-arrest/article/164767/

Tran, et al. (2010) reviews the key findings of research studies on the usefulness of therapeutic hypothermia following cardiac arrest.

3. Lutes, Michael and Larsen, Nathan (2007) Focus on: Therapeutic Hypothermia. Clinical Practice and Management March 2007. Retrieved from: http://www.acep.org/content.aspx?id=26776

Lutes and Larsen (2007) reviews recent studies that examine the use of therapeutic hypothermia, its purpose and goals as well as the methods of initiating and maintaining hypothermia and the future possible uses of therapeutic hypothermia.

4. Hartemink, Koen J., et al. (2004) Novel Applications of Therapeutic Hypothermia: Report of Three Cases. Critical Care 2004. Retrieved from: http://ccforum.com/content/cc2928

Hartemink, et al. (2004) reviews the use of hypothermia in patients with postanoxic injury following cardiopulmonary resuscitation in traumatic brain injury with high intracranial pressure.

5. Oddo, Mauro, et al. (2008) Early Predictors of Outcome in Comatose Survivors of Ventricular Fibrillation and Non-Ventricular Fibrillation Cardiac Arrest Treated with Hypothermia: A Prospective Study. Retrieved from: http://www.uthsc.edu/Internal/syllabus-journalclub/8.pdf

Oddo, et al. (2008) examines the early predictors of outcome in patients who are comatose survivors of ventricular fibrillation and non-ventricular fibrillation cardiac arrest who were treated with hypothermia.

6. Rittenberger, Jon C. (2010) Therapeutic Hypothermia: A Potent Therapy. EMS1. Retrieved from: http://www.ems1.com/medical-clinical/articles/854210-Therapeutic-hypothermia-A-potent-therapy/

Rittenberger (2010) reviews the use of therapeutic hypothermia for patients with cardiac arrest and holds that therapeutic hypothermia is a potent therapy for use in these patients.

7. Koran, Zeb E. (nd) Therapeutic Hypothermia in Postresucitation Patient: The Development and Implementation of an Evidence-Based Protocol in the Emergency Department. Retrieved from: http://www.acestar.uthscsa.edu/institute/su09/documents/Koran.pdf

Koran (nd) conducts a systemic literature review on postresucitation hypothermia and a subsequent development of a protocol that provides evidence-based criteria for patient inclusion and exclusion in the use of hypothermia initiation.

8. Graffeo, Charles, Devine, Alicia and Lo, Bruce (nd) Therapeutic Hypothermia: Emergency Medicine, Critical Care, Cardiovascular & Neurosciences Work Group. SENTARA Briefing Document. Retrieved from: http://www.emjournalclub.com/uploads/TH_Workgroup_briefing_ distributed_print_version_.pdf

Graffeo, Devine and Lo examine the use of therapeutic hypothermia in emergency medicine, critical care and Cardiovascular and Neurology patients.

9. Eisenburger, Philip, et al. (2001) Therapeutic Hypothermia After Cardiac Arrest. Current Opinion in Critical Care 2001, 7:184 -- 188. Lippincott, Williams and Wilkins, Inc. Retrieved from: http://www.wakeems.com/ICE/Hypothermia/hypothrm%20for%20tb/T herapeutic%20hypothermia%20after%20cardiac%20arrest.pdf

Eisenberger, et al. (2001) report that hypothermia has been used for cerebral protection "since the 1950s" and that the "simple principle of chemistry that a reduction of 10 degrees C. slows a chemical process by approximately 50%." In addition, it is reported that one hour or hypothermia, followed immediately by 3 hours rewarming had no significant affect on patterns of cerebral blood flow and oxygen uptake.

10. Walsh, Deborah and Edelson, Dana P. (2009) Therapeutic Hypothermia Following Cardiac Arrest. EPLAB Digest. Retrieved from: http://www.eplabdigest.com/articles/Therapeutic-Hypothermia-Following-Cardiac-Arrest

Walsh and Edelson (2009) review the history of the use of therapeutic hypothermia in patients with cardiac arrest as well as the pathophysiology of therapeutic hypothermia in patients with cardiac arrest.

Therapeutic Hypothermia Review

Part Two

The work of Sayre (2010) entitled "Effect of Pre-Hospital Therapeutic Hypothermia on Neurologic Outcome Following Sudden Cardiac Arrest" reports an EMS Trauma Research study of the Ohio Department of Public Safety. The study reports that sudden cardiac arrest is the "leading cause of death in the United States and Canada." The report additionally states that 450 cardiac arrest resuscitations are "attempted by EMS…in Columbus, Ohio each year" however it is additionally stated that only approximately 30% of those patients "survive to be admitted to the hospital." (Sayre, 2010, p. 3)

Sayre (2010) reviews the future trends both regionally and nationally and states that future trends include the "continued provision of the therapy…" (Sayre, 2010, p.3) Sayre et al. (2010) report a study that was conducted through comparison of SCA statistics for the years 2008 and 2009. No increase in the survival rates of individuals with cardiac arrest receiving pre-hospital hypothermia was found. What was found was that the neurological outcomes for individuals who received pre-hospital cooling as compared to those patients the previous year who did not receive pre-hospital hypothermia. It is reported by Sayre et al. (2010) that in a study involving 12 surviving individuals eight of these receiving pre-hospital hypothermia had initial cardiac rhythms of ventricular fibrillation. Of those eight, seven were discharged with a neurological status that was 'good' (CPC 1 or 2) and one was discharged to a skilled nursing home reporting a "severe neurologic deficit (CPC # or 4)." (Sayre, et al., 2010, p. 5)

Recommendations arising from this study include the following stated recommendations: (1) "EMS systems should continuously collect detailed, accurate and complete cardiac arrest data including neurologic outcome statistics which enable analysis of new practices and improvements in survival"; (2) "EMS professionals must maintain both skills and knowledge related to advances in resuscitation science, particularly because these patients are not encountered on a regular basis"; (3) "Improving the quality of pre-hospital care is of ultimate importance in the chain-of-survival for victims of sudden cardiac arrest. Implementation of true continuous quality improvement (CQI) is imperative. To be effective, CQI cannot be episodic or target only outliers or poor outcome. Improved survival for SCA victims reflects the quality and dedication to detail of the EMS system caring for these patients." (Sayre, et al., 2010, p.5) A charted analysis of the study reviewed in section of this work in writing is listed in the following table labeled Figure 1 in this study.

Figure 1

Analysis of Findings: Sayre et al. (2010)

There were not any apparent ethical issues to be addressed in this study other than the general consent acquisition that is needed from those participating in the study through rendering of the information concerning their treatment and outcome available to be tabulated and analyzed in the study reported. The study reported by Sayre (2010) is a qualitative and quantitative study in that the literature reviewed in the study was in the form of qualitative research and was descriptive and interpretive in nature. Patient information contained in the case study in this report is quantitative due to the information being analyzed in terms of percentages and patient outcomes. Quantitative research in this study is specifically needed so that the data relating to improved outcomes in patients with cardiac arrest and receiving pre-hospital hypothermia treatment can be best analyzed.

Therapeutic Hypothermia Review

Part Three