The Original Hypothermia Protocol

  1. Induce sedation by IV midazolam (0.125/KgBW/hr initially) and fentanyl (0.002mg/Kg/hr initially) and adjust dose as needed x 32h for management of mechanical ventilation
  2. Induce paralysis by IV pancuronium (0.1mg/Kg) q2h x 32h to prevent shivering
  3. Measure initial temperature using an infrared tympanic thermometer, and measure subsequent temperature with a bladder probe
  4. Cool to target temperature of 32-34C with external cooling device (TheraKool, Kinetic Concepts, Wareham, UK), to reach goal within 4h after ROSC.
  5. Apply ice packs if goal not achieved.
  6. Maintain temperature x 24h from start of cooling, followed by passive rewarming (expected to occur over 8 hours.

Inclusion:  witnessed cardiac arrest, initial cardiac rhythm is Vfib or nonperfusing Vtach, presumed cardiac origin of arrest, 18-75y, collapse to resuscitation by EMS 5-15mins, collapse to ROSC not >60mins.

Endpoints: neurologic outcome within 6 months; mortality within 6 months, rate of complications within 7d

Results:  55% vs 39% with favorable neurologic outcome (CPC1/2) RR 1.4, 95% CI 1.08-1.81; ortality at 6 months 41% vs 55% RR 0.74 95%CI 0.58-0.95

Implications:   

  1. NNT to prevent 1 death:  7 (95%CI 4-33)
  2. NNT to prevent 1 unfavorable neurologic outcome:  6 (95%CI 4-25)

References

‘Mild Therapeutic Hypothermia To Improve The Neurologic Outcome After Cardiac Arrest’. New England Journal of Medicine 346.8 (2002): 549-556. Web.

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