In early December, the Emergency Departments at Cary Hospital and North Healthplex began supporting induced hypothermia for patients who present after cardiac arrest. Induced hypothermia is a unique chilling process using a cold saline IV, ice packs, and a special central venous catheter that is placed in the femoral vein by an emergency department physician.
Research shows that patients who regain a pulse quickly after cardiac arrest may suffer injuries from blood flow resuming too quickly to the brain, often resulting in brain death or severe brain injury. This research has demonstrated an improved neurological outcome for patients who are cooled for the first 12 to 24 hours after they have a return of pulse.
The Raleigh Campus has offered induced hypothermia for 12 years for specific indications, including traumatic brain injury and intracranial pressure control. In October 2006, we energized our efforts in response to a community-wide initiative to coordinate field-to-hospital use of induced hypothermia therapy for select cardiac arrest patients. Last fall, Wake County EMS acquired the expertise and equipment to begin the cooling process while in the field, and WakeMed purchased three Coolgard intravascular cooling machines to accurately cool and rewarm patients in the Emergency Department and Intensive Care Units. Mobile Critical Care Services will soon also become one of the only mobile services in the country able to continue induced hypothermia therapy while in transit.
'To date, the Raleigh Campus has cooled over 70 patients who range in age from 17 to 96 with excellent overall results, and we are pleased to be able to roll out this therapy to emergency departments across the system,' commented Eric Reyer, RN, Emergency Services.
WakeMed's induced hypothermia patient inclusion criteria include:
> Non-traumatic cardiac arrest with return of spontaneous circulation;
> Core temperature of greater than 93.2 degrees F;
> Time to initiation of hypothermia is less than six hours;
> Comatose after return of spontaneous circulation: GCS less than eight and no purposeful movements to pain.
