Core Cooling In Cardiac Arrest & Stroke Patients

[x635 4,066]

Recently, there's been a lot of "buzz" about intervenous cooling of patients suffering an MI or stroke prehospitally. There's even an article about it in this month's issue of JEMS.

Is any agency in the area looking into, or participating in the clinical trials for what's looking to be a future standard for EMS care. The studies look very promising.

[JJB531 652]

Recently, there's been a lot of "buzz" about intervenous cooling of patients suffering an MI or stroke prehospitally. There's even an article about it in this month's issue of JEMS.

Is any agency in the area looking into, or participating in the clinical trials for what's looking to be a future standard for EMS care. The studies look very promising.

I'd assume since this is a progressive form of prehospital medicine, we won't be seeing it in NY until 2050....

[fac911 33]

I heard that FDNY * EMS is going to be playing around with it.

[weaselff 6]

I heard that FDNY * EMS is going to be playing around with it.

Somebody drinks the coolaid.

[fac911 33]

Somebody drinks the coolaid.

What's your comment mean? I don't get it

[JBE 328]

He means the Kool Aid of propaganda and BS that gets spewed from 9 Metrotech. However, it sounds like an interesting idea, cooling the body to prevent the spread of further damage, I suppose??

[ny10570 745]

This is not MetroWreck koolaid. The plan is for a small refrigerator large enough for 2 1,000cc saline bags (apparently its all ready been picked out). Get a pulse back on an arrest and they buy themselves a large bore IV and a liter of ice cold saline on the way to the ER. The plan is to begin the cooling process that will be continued at the ER.

Its all still a way off, its part of a larger plan to improve the arrest survivability numbers in the city. The dept is going to designate cardiac arrest hospitals and to qualify they have to provide certain services and meet certain standards. I don't remember all of the qualifications required but there was nothing outrageous with the idea being that every 911 receiving facility could comply with minimal effort. They were all centered around establishing a standard of care citywide so that any interventions begun in the field would be continued at the receiving facility.

[Oswegowind 17]

This is new protocol at least at some local hospitals. My wife works at St. John's ER in Yonkers and was telling me about this. Sounds like it is worth a try, it definitely won't hurt them any further! We will see how it works and then how it is adapted!

[Skooter92 7]

Stamford EMS will be trialing this fairly soon. We are doing it in steps, the first being adopting the E-Z IO drill, which is on all rigs right now, the second step then is to work out the logistics of providing cooled saline to victims of SCA with ROSC. What will probably happen (per reliable source) is if a medic unit has a "fresh" arrest with high probability of ROSC or god forbid an actual save, the supervisor will roll to the scene and provide cooled saline from a fridge on the 901 truck. Makes more sense in our system than putting a beer fridge on each unit, although every rig has an installed Temperature Control Unit (TCU) for the drug bag.

[efdny2003 16]

This sounds like a great idea and like it could possibly be beneficial, but it also only sounds like something that can be done by a medic. Are there any plans or talk for ways to accomplish this on the EMT-B level or is it only on the medic level? I only ask because at times a medic may not be available or you have one coming mutual aid thats 5-6 minutes away that you rendezvous with...theres still that time gap between meeting with the medic or getting to the hospital. Also, is this something in the works only if you get the victim of cardiac arrest back or is this if its a confirmed arrest period.

[ny10570 745]

All the protocols I've seen for cardiac arrest cooling involve post arrests. Since BLS rarely get BLS only saves and the few they do get do extremely well just based on practicality I don't see much reason for this to become a BLS procedure. However I'm familiar with a story about a guy arresting in a supermarket where the BLS crew packed the guy in frozen vegetables after ROSC. I'm going to assume that if hypothermia became a standard treatment in your area and as a BLS you packed a post arrest in frozen peas you would be commended rather than punished.

[Skooter92 7]

The target temperature is 92 degrees farenheit, or so I've been told. How many bags of frozen veggies would it take to chill, say, a 100 kg patient to that desired temp? Peas vs. corn vs. broccoli? Brand name vs. store brand?

I ask ONLY for clinical reasons.

[Goose 188]

I read about some county wide EMS system in the South that does this about two years ago. The sup's truck has a some sort of refridge or ice box with 1000 bags and is dispatched along with their medic units to any possible arrest. Apparently it worked well for them.

[RWC130 594]

Anything that may help save a life I am all for!

I'd like to see some more information on this.

Anyone have some?

Oh, by the way.... Skooter92!

I'd go with ICE from the Seafood Department for

the Cardiac Arrest in the A&P! lol

[ny10570 745]

Without actually reading the research myself the only numbers I remember are an increase in neurologically intact discharges from 40% to 55% in one study and another study in Australia reportedly doubling the percentage of post arrests surviving with "good" neurological function intact. Now it turns out there will not be an effort to get all hospitals involved as some cannot meet the demands. A few hospitals in each borough that will be made into Resuscitation Centers and anyone with ROSC will be transported to one of these facilities where the cooling process will continue and other interventions begun. The cold saline being infused isn't suppose to cool the pt into hypothermia. It is only suppose to begin the cooling process and facilitate the receiving facility's cooling efforts. Actually cooling the patient too far in the field results in shivering, bradycardia, and other problems that you either can't or just don't want to deal with in EMS. if anyone is interested on getting some more edumacation on this, PM me I have a couple articles here that I have to get through that I can pass along.

[DR104 141]

This has nothing to do with cardiac or strokes. But they did a core cooling on that football player from the Bills. They are saying that it saved him from a life in a wheelchair.

[Skooter92 7]

Dr. Paul Hinchey (any of you old Empress people-remember him?) did a presentation before the Westchester conference up in Stamford on core cooling. Very impressive, and definitely worth a shot as the cost involved is minimal and the potential return if the protocol is intiated pre-hospitally and extended into the receiving facility is huge. For a county-wide trial, it would take every hospital (not just the ED) in Westchester to fully sign on-highly improbable. In Stamford, it's a matter of just doing it-all the stakeholders are on board. Seems to me if it's cheap and easy....but in Westchester, it's all about turf and ego.

[DOC22 1]

Dr. Paul Hinchey (any of you old Empress people-remember him?) did a presentation before the Westchester conference up in Stamford on core cooling. Very impressive, and definitely worth a shot as the cost involved is minimal and the potential return if the protocol is intiated pre-hospitally and extended into the receiving facility is huge. For a county-wide trial, it would take every hospital (not just the ED) in Westchester to fully sign on-highly improbable. In Stamford, it's a matter of just doing it-all the stakeholders are on board. Seems to me if it's cheap and easy....but in Westchester, it's all about turf and ego.

That's the sad part--Turf and Ego! All that crap should be left at headquarters when it involves something that has great potential to save lives! JMHO

[ny10570 745]

Its cheap and easy pre-hospitally, but from what I understand the continuation of the therapy is much more involved and not easily accomplished in all facilities.

[Skooter92 7]

Actually, per Paul, the device to maintain core cooling is fairly inexpensive and mainly requires an ICU. The clinicians involved need to be educated and on board, but the cost is not huge.

Edited June 22, 2008 by Skooter92

[Skooter92 7]

Had our monthly CME tonight at Stamford Hospital, and per our clinical coordinator we are starting cooling next week. I'll get a copy of our clinical guideline and post it if anyone is interested.