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Implementation of Therapeutic Hypothermia Protocol: Restoring Neurological Functioning in Post-Cardiac Arrest Patients

What are we looking to improve?
Induced hypothermia has been applied for a variety of medical conditions, most effectively in patients who are comatose after cardiac arrest. The practice (which follows guidelines from the American Heart Association and the International Liaison Committee on Resuscitation) calls for patients who experience a return of spontaneous circulation after cardiac arrest to be promptly cooled to 32 degrees to 34 degrees Celsius. Study data shows improved neurological recovery in these patients. Through our initiative, we want to bring cardiac patients to full neurological recovery after warming.

What strategies/measures have we implemented for improvement?
Mount Sinai St. Luke's Roosevelt’ multidisciplinary committee, led by critical care, cardiology and emergency-medicine clinicians, developed a hypothermia protocol that requires:

  • Attaching balloons filled with cold water measuring 33 degrees Celsius to a catheter, which is then inserted through the femoral vein.
  • Employing a rectal probe to gauge and maintain body temperature.

What have we accomplished to date?
Since 2008, 31 patients have been admitted to Mount Sinai St. Luke's Roosevelt following out-of-hospital cardiac arrest due to ventricular fibrillation or ventricular tachycardia. Forty-four percent of these patients survived with intact neurologic status. Our results indicate the success of hypothermia in returning patients to their pre-cardiac arrest functioning. We have been designated a hypothermia receiving center as part of New York City Project Hypothermia.

What are our future plans?
We will continue to hold educational forums and lectures for our medical staff and conduct ongoing protocol improvements.

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