In week three of the Massive Open Online Course from Coursera on the topic of Cardiac Arrest, Hypothermia, and Resuscitation Dr. Abella discussed the reason for and action of therapeutic hypothermia for patients with return of spontaneous circulation (ROSC).
Excellent and Thorough Presentation
I have read, listened to, and watched hours and hours of training on this topic. This was by far the most thorough and well explained discussion of therapeutic hypothermia I have experienced. Bravo!
Reperfusion Injury Explained
Dr. Abella used an excellent metaphor (car runs out of gas, car is refilled with gas, car explodes) to explain reperfusion injury. An aha moment for me.
Hypothermia through the Ages
We took a tour through time and geography to understand historical uses of hypothermia to treat ischemia. In the modern era hypothermia has been advocated as a treatment for ROSC as far back as the 1950s and 1960s. It wasn’t until three randomized clinical trials in the early 2000s that the case was made for hypothermia and it became a Class I recommendation (name the other Class I recommendations for bonus points).
Discussion of Practical Issues
Four questions are commonly asked about therapeutic hypothermia.
How to cool? A method that has thermostatic control meaning once a therapeutic temp is achieved there is little variation.
When to cool? This question was a little less clear. He first said, “as soon as possible.” Then in the next minute Dr. Abella said, “Within a few hours.” For prehospital providers this is a critical distinction because it impacts whether EMS is participants in therapeutic hypothermia through field initiation or not.
How cold to cool? The target temperature range is 32-34C.
How long to cool? I did not hear an answer to this question in the presentation. The three randomized control trials each cooled for a different time period – 4, 12, and 24 hours.
Post Arrest Bundle of Care
The course video for week three concluded with a discussion that therapeutic hypothermia doesn’t exist in a vacuum. Nor is it a definitive treatment. Many patients that achieve ROSC still die or survive with a very poor neurological outcome.
Resources
A course reading list has been created. Unfortunately due to copyright restrictions it is a list of citations rather than full text PDFs of research studies.
Center for Resuscitation Science at U Penn
Hypothermia and Resuscitation Institute at U Penn
Pop Culture References
Despite several opportune moments Dr. Abella made no mention of freezing Captain Solo in carbonite or putting Captain Solo into the cargo hold. He did mention, with a smile of admiration, the movie Flatliners.
