“Cooling” is based on the theory that hypothermia can help stabilize patients in cardiopulmonary arrest and improve neurological outcomes.
Cooling should be started as soon as possible when applied (within 6 hours). It should be used in non-traumatic cases of cardiac arrest when ROSC is obtained within 30 minutes. There should be a low GCS and NO purposeful movement. Female patients should not be pregnant.
Parameters to use when titrating temperatures:
- MAP >65 or 90 when concerned about ICP
- PCO2 35-45
- FiO2 > 94%
- RASS -5
- EEG monitoring
You should be able to see a J-point on EKG:
- Shivering and seizures (can use paralytics if there is concern this is causing respiratory complications. I’ve heard of surgeons using meperidine but haven’t done this myself)
- Skin injury from the pads
- Bradycardia refractory to atropine
NB: if there is any question about brain death, you need to wait 72 hours until after someone comes off the cooling protocol to make any determination of prognosis.