Welcome to winter. Many of us will be experiencing a cold challenge – unintentionally – as we respond to patient emergencies. Will you be inducing hypothermia in any of your patients?
I don’t work in EMS systems that use induced hypothermia for patients that have Return of Spontaneous Circulation” after cardiac arrest – yet. Despite inclusion of induced hypothermia as a Class IIa recommendation in the 2005 American Heart Association Emergency Cardiac Care Guidelines this treatment has not been universally adopted by EMS systems and receiving hospitals.
I am told the main obstacle to adoption in my work areas is the hospitals, in both the ER and ICU, are not ready to maintain and monitor mild induced hypothermia and thus it does not make sense for EMS to initiate it. I am not sure if this is actually true, rumor, or simply passing the buck.
Common barriers to initiating an induction of hypothermia protocol after ROSC include:
1. Uncertainty about how soon hypothermia should be initiated. Although practitioners, in and out of the hospital, that have perform induced hypothermia universally have told me induction should begin as soon as possible.
2. Need for additional equipment to maintain chilled IV fluids and ice packs for rapid use. Ambulances are already filled with a lot of equipment that is used infrequently. A cooling device, about the size of a small cooler, that will be used for <1% of patients occupies a lot of valuable real estate.
3. Infrequency of sudden cardiac arrest patients that achieve ROSC. Induced hypothermia is just a small part in the total package of services to prevent SCA. Many communities don’t even know there cardiac arrest survival rate. If conversion of V-Fib to a pulse is hovering in the low single digits other system changes and protocol advancements might be a higher priority. What is your communities sudden cardiac arrest survival rate? I don’t have any idea what the rate is the places I work/have worked. The closest estimate I have gotten is “dismal” or “it depends on how we measure survival.”
Despite these barriers all EMS professionals should be aware of the use of induced hypothermia for ROSC patients. Change may come rapidly. Use an online CE class (like the lesson on inducing hypothermia from RapidCE), this slideshare presentation, conference presentations, ACEP News Article from March 2007, and other opportunities to learn about induced hypothermia protocols and equipment. Your service may be next.
This is a post in the 31 days of CE series for EverydayEMSTips.com