Abstract
Introduction: Hypothermia in patients after Return of Spontaneous Circulation (R.O.S.C.) was recommended in the 2005 American College of Cardiology/American Heart Association Guidelines. Prehospital use of cold saline (32-34°c) and ice packs to the proximal extremities, has been used for patients with R.O.S.C.. In hospital use of intravascular cooling and heart catheterization yield the best neurological and cardiac outcomes as recommended by the A.C.C./A.H.A. 2008 guidelines. METHODS: A retrospective chart review was conducted spanning 3/2009 to 9/2010. Including prehospital run sheets and hospital records. Prehospital provider protocols for 968 paramedics (11 municipalities) were modified to allow the providers to place ice packs at the proximal extremities and to start iced saline I.V. (temp 32-34°c) for victims of cardiorespiratory arrest with R.O.S.C. On arrival to the hospital the cardiologist and the emergency physicians started internal cooling of these patients. The cardiologist and the catheterization team diagnosed and treated preexisting coronary disease in the catheterization laboratory. Cooling was continued for twenty four hours. The patients were then evaluated to determine their level of neurological function prior to discharge. Results: 31 patients were brought in by paramedics after starting the prehospital hypothermia protocol, after R.O.S.C. 26 men and 5 women. All patients were admitted through the emergency department to the heart catheterization laboratory where central cooling was started and coronary angiography was performed, with angioplasty and stenting was done when indicated. Cooling was at 32°c and was maintained for 24 hours. 13/31 patients expired prior to discharge (42%) from the hospital. 5/31 patients were transferred for hospice care or to long term-care facilities (16%). 12/31 patients left the hospital neurologically intact (39%). Conclusion: The sequential use of prehospital cooling and inhospital intravascular cooling for victims of cardiorespiratory arrest with R.O.S.C. is feasible, safe and effective. Our results for neurologically intact hospital discharges of 39%, is higher than that reported by prior investigators.
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