Who is a candidate for TTM?
Intubated patients with treatment initiated within 6 hours after cardiac arrest (nonperfusing VT or VF) Patients able to maintain a systolic blood pressure above 90 mm Hg, with or without pressors, after cardiopulmonary resuscitation (CPR) Patients in a coma at the time of cooling.
When is TTM contraindicated?
Candidates for TTM Relative contraindications include – pregnancy, traumatic arrest or active bleeding, uncontrolled arrhythmia or hypotension, pregnancy, severe sepsis, and terminal illness with <6 months expected mortality, poor baseline mental status, DNR.
When do we use TTM?
TTM is recommended for all patients with return of spontaneous circulation (ROSC) from cardiac arrest who have abnormal conscious levels during the immediate post-arrest period.
How do you monitor therapeutic hypothermia?
Monitor and document vital signs every 15 minutes X4, every 30 minutes X2, then every 1 hour with the exception of patient temperature, which will continue every 15 minutes until reaching target temperature of 33°C. Continually monitor cardiac rhythm documentation at least every 6 hours and with any rhythm changes.
What is used for therapeutic hypothermia?
In general, two methods of induced hypothermia are used currently: surface cooling and endovascular cooling. Surface cooling methods include convective air blankets, water mattresses, alcohol bathing, cooling jackets, and ice packing. Surface cooling techniques have been used for many years in the treatment of fever.
Who needs targeted temperature management?
The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32°C and 36°C for at least 24 hours.
How long should you wait to determine the neurological prognosis of a patient treated with targeted?
There is evidence that neurological outcomes evolve between 1 and 6 months after cardiac arrest. In an American Heart Association consensus statement on primary outcomes after cardiac arrest, the consensus was to assess neurological outcomes at 3 months after discharge.
What is an absolute contraindication to targeted temperature management or therapeutic hypothermia?
Further, they recommend selecting and maintaining a constant temperature between 32 degrees C and 36 degrees C during TTM. Absolute contraindications to TTM are an awake and responsive patient, DNR, active non-compressible bleeding and the need for immediate surgery.
Is TTM still recommended?
Current guidelines already recommend use of TTM as a Class I indication for patients with a nonshockable rhythm (level of evidence, C) , which is likely to remain unchanged in light of the HYPERION trial.
What is the goal of targeted temperature management?
Targeted temperature management aims to reduce mortality and improve neurological outcomes in unresponsive patients who achieve ROSC after cardiac arrest.
What is the only contraindication for targeted temperature management?
Which patients are eligible for induced hypothermia?
Answer Patients who have been shown to benefit from induced hypothermia include the following; however, strict inclusion criteria vary by institution: Intubated patients with treatment initiated within a 6-hour post cardiac arrest (nonperfusing ventricular tachycardia [VT] or ventricular fibrillation [VF]) time window
What are the guidelines for therapeutic hypothermia comatose?
Summary of Practice Guideline Recommendations for Therapeutic Hypothermia Comatose (ie, lack of meaningful response to verbal commands) adult patients with ROSC after out-of-hospital VF cardiac arrest should be cooled to 32°C–34°C (89.6°F–93.2°F) for 12 to 24 h ( Class I; Level of Evidence: B ).
What are the contraindications to therapeutic hypothermia?
In such cases, targeted temperature management may still be used to achieve normothermia. Absolute contraindications to therapeutic hypothermia include hemorrhagic stroke, GCS > 8, uncontrolled bleeding, uncontrolled hemodynamically unstable rhythms, and cardiac arrest due to trauma.
What is therapeutic hypothermia for post cardiac arrest?
THERAPEUTIC HYPOTHERMIA PROTOCOL FOR PATIENTS IMMEDIATELY POST CARDIAC ARREST. 1. Patients who meet inclusion criteria post cardiac arrest should have their core body temperature reduced to 32° – 34°C as soon as possible, ideally within 4 hours of return of spontaneous circulation (ROSC).