Therapeutic hypothermia
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Background
- Determination of Neurologic Prognosis is unreliable before at least 72 hours after ROSC. Do not neuroprognosticate until 72 hours post rewarming.
Exclusion/Contraindications
- >12hrs since ROSC
- Glasgow Motor score >5
- Minimal pre-morbid cognitive status
- Other reason for coma
- intracranial pathology (i.e. intracranial hemorrhage, ischemic stroke)
- subarachnoid hemorrhage
- sedation
- Sepsis as etiology for arrest
- DNR/DNI status
- Uncontrollable bleeding
- Significant trauma (especially intra-abdominal)
Sedation
Should administer one or more of the following:
- Fentanyl Injection 50 mcg IV every hour as needed for pain.
- Fentanyl IV infusion NSS
- Propofol IV infusion
- Lorazepam IV infusion
- Lorazepam Injection 1 mg IV every 2 hours as needed for agitation.
- Pancuronium IV infusion
- Initiate before initiating cooling. Dosing recommendations: 0.1 mg/kg loading dose followed by a continuous infusion of 0.33-2 mcg/kg/minute.
- Do not use in patients with renal and/or hepatic insufficiency.
Management
- Consider head CT
Disposition
- ICU admission
See Also
Source
- University of Pennsylvania Targeted Temperature Management Protocol