Ask the Experts: Therapeutic Hypothermia
Anna Ek, BSN, RN, AACC
Accreditation Review Specialist
Anna Ek has a strong background in cardiac, surgical, and PACU nursing. She began her nursing career during the time of thrombolytic trials which ignited her longtime passion for cardiology. She has a strong interest in EMS practices and has met with EMS throughout the United States. She is a strong advocate of EMS and the part they play in the pre-hospital care of the cardiac patient. In addition, Anna has a keen interest in induced hypothermia therapy and continues to research its effects on the post-cardiac arrest patient.
Anna Ek is the in-house expert on drastically improved outcomes for the patient population because of therapeutic hypothermia treatments and "cooling centers."
Q: Talk a little bit about what you're seeing in the market in terms of advancements in hypothermia ...
A: Therapeutic hypothermia applications and protocols have not changed much in the last ten years. What has changed is the availability for patients to receive treatment post cardiac arrest in many regions of the country and world. More people in the country are aware of and are trained on bystander CPR and use of AEDs, vastly impacting survivability with intact neurological status. The impact of EMS assuming the care of the patient and transporting the patient to "cooling centers" has also drastically improved outcomes for this patient population.
The staff within the hospital setting have the patient under critical care for at least 24 hours of cooling time. During this time the patient is cooled, has vital signs, lab work, EEG and ECG monitoring constantly. It requires extra staff, technology and resources 24/7, thus the appropriate destination for EMS. We are encouraged by the community education aspect and its potential in the young cardiac arrest patient survival. Too many student athletes and people with no heart attack risk factors or coronary artery disease are dying. The newest campaign by the Sudden Cardiac Arrest Association emphasizes this difference.
We have this discussion with our partner facilities and are invigorated by the rapidly increasing participation in this effort. Community education is part of our criteria for ACS, heart failure and atrial fibrillation. We are hopeful that this topic will soon enter the community's conscience as well.
Q: It's interesting that student athletes have benefitted. What percent of hospitals have "cooling centers?"
A: There are more hospitals providing this care every day. We find the majority of them in metropolitan areas, but it is a possibility in mid-size and smaller facilities as well. It does require resources and staff to implement the protocols appropriately.
Q: What hurdles do they face in terms of financial commitment, or in terms of education to get a team fluent on building a cooling center?
A: While it takes resources to have therapeutic hypothermia at a hospital, it is not a huge financial barrier up front. The training on the cooling equipment is generally done by the sales representative for the staff. The probe, pads or blankets are not cheap, but considering overall costs, it lessens intensive care time and length of stay when the patient improves. These are truly critical patient scenarios and these loved ones deserve every possibility for survival. Long term care and therapy is where much of the care for a lot of these patients takes place, much as in the acute care setting. They may have some residual neurological and physical deficits that need to be addressed.
Q: So, is it fair to say therapeutic hypothermia applications are a trend you are seeing? And do you see that trend continuing?
A: I wouldn't call it a trend; it is an evidence-based treatment protocol. I see it as standard of care for appropriate patient populations. Therapeutic hypothermia is not appropriate for all cardiac arrest patients, but I imagine that we will see non-cardiac arrest applications for other scenarios such as MI and stroke. We have seen it grow exponentially in its availability and application.
Q: Do you foresee every facility having a cooling center eventually?
A: No, because EMS will generally take patients to facilities that have a Cath lab, bypassing non-PCI facilities. Perhaps we will see therapeutic hypothermia in facilities for other applications in those instances. We may see some rural facilities treat these patients in order to keep the patient in their own community.
Q: Like what?
A: Applications such as stroke, MI and other morbidities determined in the future.