Use of ice-cold crystalloid for inducing mild therapeutic hypothermia following out-of-hospital cardiac arrest.

Abstract

OBJECTIVE:

Out of hospital cardiac arrest (OHCA) results in a significant mortality and neurological disability in survivors. The application of mild therapeutic hypothermia (MTH) to patients who have suffered an OHCA with a ventricular rhythm results in a significant reduction in mortality and neurological disability in survivors. The optimal timing of this intervention has not been clearly established; however there is emerging evidence to suggest that maximal benefit is gained from initiation at the earliest time point. Despite this, recent surveys have shown a considerable delay in initiating MTH, with variable uptake in emergency departments (EDs), where a number of impediments to delivery have been identified.

METHOD:

We have reviewed the literature to determine what are the barriers to the initiation of MTH in the ED. We also reviewed the literature on the use of ice-cold crystalloids as a practical, simple, effective, and safe method to induce MTH.

RESULTS:

Among the several reasons, the perception of a lack of a practical method and logistical constraints are cited as common barriers. However, the available literature on the use of ice-cold crystalloids suggests that this is a safe and effective method of inducing MTH.

CONCLUSION:

ED staff need to be aware that the use of ice-cold fluids is an inexpensive, readily available and easy to perform method of inducing MTH in patients who suffer an out-of hospital cardiac arrest with a ventricular rhythm. We therefore suggest that ice-cold crystalloid is routinely stocked in emergency departments and, unless contraindicated, is used to induce MTH. Optimal post-resuscitation care also includes timely treatment of the cause of the OHCA and maintenance of MTH. Staff education and care bundles may help to facilitate optimal inter-departmental management of the patient.

• Authors: N Arulkumaran, R Suleman, J Ball
• Journal: Resuscitation (Resuscitation) Vol. 83 Issue 2 Pg. 151-8 (Feb 2012) ISSN: 1873-1570 [Electronic] Ireland
• PMID: 22001003 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Crystalloid Solutions
• Isotonic Solutions
• Rehydration Solutions

Topics

• Cardiopulmonary Resuscitation (methods)
• Crystalloid Solutions
• Heart Arrest (therapy)
• Humans
• Hypothermia, Induced (methods)
• Isotonic Solutions (pharmacology)
• Out-of-Hospital Cardiac Arrest (therapy)
• Rehydration Solutions
• Treatment Outcome