Hypothermia Post Cardiac Arrest
Temperature monitoring in patients who qualify for therapeutic hypothermia should now be done by esophageal probe. Esophageal temperatures are more accurate than rectal ones in this setting, namely rapid temperature changes. The esophageal temperature probe is nothing more than a standard rectal probe placed in the esophagus. At least for now, this is a physician-only procedure (outside of the OR). Instructions are as follows:
ESOPHAGEAL TEMPERATURE PROBE PLACEMENT:
Proper placement of the esophageal probe sensor is essential for the accurate measurement of core temperature. If it is too high in the esophagus the reading will be affected by tracheal air. Placement in the lower third of the esophagus, in proximity to the heart and aorta, will reflect core temperature.
Esophageal Probe Insertion:
Measure from the corner of the mouth to the ear lobe to 2 cms. above the xyphoid process to determine the insertion length
Lubricate and insert probe
Secure the probe. A Chest x-ray should be performed to confirm proper placement.
Attach probe to temperature cable and monitor
For all patients who arrive in, or after,
witnessed cardiac arrest: we would like to capture time
of arrest (or approximate time of arrest) for the
purpose of evaluating our resuscitation & post-arrest process &
outcomes. The EMS run sheet has a blank for time of
arrest, but it is not consistently recorded so it will be up to
us to determine the info, with the help of EMS, and convey it to
the nurse doing documentation.
For patients in arrest: Anil Mani of Cardiology has requested that we simplify the code process by defibrillating only at 200J for all shocks. The 2010 AHA guidelines recommend an initial dose of "120 to 220J" (Class I, LOEB), with subsequent doses the same or higher. No difference in harm or benefit between the two doses has been shown.
Therapeutic
Hypothermia Protocol for Patients Immediately Post Cardiac Arrest