Post-resuscitation in Irish hospitals

m4r10

I'm wondering what are the guidelines for post-resuscitation in Irish hospitals? Read that the new guidelines for post-resuscitation is to induce the patient into a therapeutic hypothermia for 12-24 hours as, according to some studies and trials, helps the recovery.

Do someone knows if this is implemented in our hospitals or even if the equipment necessary for this procedure is available in Ireland?

Bang Bang

m4r10 wrote: »

I'm wondering what are the guidelines for post-resuscitation in Irish hospitals? Read that the new guidelines for post-resuscitation is to induce the patient into a therapeutic hypothermia for 12-24 hours as, according to some studies and trials, helps the recovery.

Do someone knows if this is implemented in our hospitals or even if the equipment necessary for this procedure is available in Ireland?

Yes it has been implemented and is now in practice.
Active cooling with cold packs placed at the armpits, groin and abdomen is also a part of the Post-Resuscitation Care CPG for Advanced Paramedics and Paramedics.

kub

Sorry what does all of that mean to us no so medical folk?

Bang Bang

kub wrote: »

Sorry what does all of that mean to us no so medical folk?

Anoxic brain injury or the starvation of oxygen to the brain occurs when a person suffers a cardiac arrest. Therapeutic cooling of the body following successful resuscitation causes the metabolism of the brain to alter so it's oxygen demand or requirement is reduced. This has proven to aid brain recovery and reduce inflammation in the brain therefore increasing the possibly of a full recovery with no brain damage.

It is much more scientific than what I've stated but that is it in a nutshell really.
I hope this helps.

m4r10

Bang Bang wrote: »

Yes it has been implemented and is now in practice.
Active cooling with cold packs placed at the armpits, groin and abdomen is also a part of the Post-Resuscitation Care CPG for Advanced Paramedics and Paramedics.

So basically what they're doing is applying ice packs on the patient! With this method there's no way of mentaining a constant low temp as required.
It's good to know that at least the method is in practice, although at a basic level.

Bang Bang

m4r10 wrote: »

So basically what they're doing is applying ice packs on the patient! With this method there's no way of mentaining a constant low temp as required.
It's good to know that at least the method is in practice, although at a basic level.

To clarify, the ice pack treatment is predominately pre-hospital by Paramedics and Advanced Paramedics. In-hospital therapeutic cooling may be and is often done invasively, but ice packs, cold blankets and environment control techniques are also used in-hospital.

m4r10

Thanks for the inside tips!

Bang Bang wrote: »

To clarify, the ice pack treatment is predominately pre-hospital by Paramedics and Advanced Paramedics. In-hospital therapeutic cooling may be and is often done invasively, but ice packs, cold blankets and environment control techniques are also used in-hospital.

For whoever is interested in the above technique, here are a few articles about it:

http://www.nejm.org/doi/full/10.1056/NEJMoa003289
http://www.nejm.org/doi/pdf/10.1056/NEJMoa012689
http://circ.ahajournals.org/content/108/1/118.full

truebluesac

Induced hypothermia is initiated only if the patient's resposivness doesnt improve after 15-20 mins .

Iv had ROSC and patients be talking to you before you get to the hospital .

timmywex

Bang Bang wrote: »

Yes it has been implemented and is now in practice.
Active cooling with cold packs placed at the armpits, groin and abdomen is also a part of the Post-Resuscitation Care CPG for Advanced Paramedics and Paramedics.

Its also in the CPG's for EMT's and CFR-A's

ectoraige

When my father was in intensive care post-ROSC back in 2009, cooling was achieved using cooling blankets, chilled IV, and I believe a cooling catheter that acted as a heat exchanger. The room itself was also chilled. The intensive care nurse explained a lot about the research and I believe at the time that it was relatively new to Irish hospitals.

There are devices to initiate cooling in a pre-hospital environment, mostly portable cooling blankets I believe. There is also an interesting product called RhinoChill which applies a cold nasal spray to the patient to provide rapid cooling. I don't know if any such devices are used here, or if it's just ice-packs and wet blankets.

stevie06

ectoraige wrote: »

There are devices to initiate cooling in a pre-hospital environment, mostly portable cooling blankets I believe. There is also an interesting product called RhinoChill which applies a cold nasal spray to the patient to provide rapid cooling. I don't know if any such devices are used here, or if it's just ice-packs and wet blankets.

Pre-Hospital cooling is still very much a new practice, not only in ireland but globally (there are a few centres that are leading the way) so technology and the use of the same is very limited. but also the evidence behind pre-hospital cooling isn't there to say that it is effective, (makes a difference to survival to discharge), that said there is plenty of evidence to say that induced hypotermia is effective, it is just the question of weather starting it pre-hospital is of use, until that question is answered, very little captial expenditure is going to happen on technology for improving the effectiveness of pre-hospital cooling.


Ice packs to the core (arm pits, abdo and groin) are more of a cursory effort......... there effectiveness is still being looked into, with the most effective method prehospital at the moment being chilled fluids (again the evidence isnt robust).

the best place to cool the patient is in hospital where they have the equipment and it can be closely controlled. that said, i would still start it pre-hospital, but it is just not proven that it effects outcome, but it certainly does no harm.


they use that Rhino cooler in HEMS in london...... it would be interesting to see if they have found it of use, but again, the transport times from scene to hospital is generally short so it is hard to get good data.....