In an effort to improve the neurological outcomes of resuscitated cardiac arrest patients, the MediSys Health Network is now participating in a FDNY initiative called “NYC Project Hypothermia.”
As part of the project, Brookdale, Flushing, and Jamaica Hospitals, as well as several other New York City hospitals, will follow protocol to induce hypothermia (lower body temperature) in patients who survive cardiac arrest and show evidence of brain injury.
The procedure, called therapeutic hypothermia, involves three phases— cooling, maintenance, and re-warming. Hypothermia is induced within 4 hours of patient’s arrival in the emergency room. A variety of cooling techniques, including ice packs, cooling mattresses, and cooling catheters, are used in combination with chilled intravenous fluids for inducing hypothermia. Once cooled to between 32-33 C, patients are maintained in a hypothermic state and closely monitored for 24 hours. During this time, physicians watch for and treat potential complications. For an additional 16 hours, patients are slowly re-warmed to normal body temperature.
Throughout the cooling process, patients are also administered all other post arrest treatments.
“When a person is in cardiac arrest, not only do they lose heart function during that time, but they lose blood to their brain as well,” explained Dr. Lewis Marshall, Chairman of Emergency Medicine at Brookdale Hospital. “The purpose of cooling these patients is to help maintain their brain function.”
“In essence, cooling places the brain in “hibernation.” It slows down brain function and decreases the brain’s need for oxygen. This gives the brain a chance to recover,” added Dr. Geoffrey Doughlin, Chairman of Emergency Medicine at Jamaica Hospital.
Eligible criteria for therapeutic hypothermia include patients successfully resuscitated within 30 minutes after their arrest and who present evidence of potential brain malfunction. Individuals must also be older than 18 years old.
“Resuscitating cardiac patients is important, however, our goal with this project is to get patients back to normal functioning,” said Dr. Robert Crupi, Chairman of Flushing Hospital’s Emergency Department.
The American Heart Association and the International Liaison Committee on Resuscitation now recommends using therapeutic hypothermia for unconscious patients with spontaneous circulation after cardiac arrest.