The University Health System adopted target temperature management for patients post-cardiac arrest as a means to improve survival after the American Health Association approved the measure.
The goal of targeted temperature management is to reduce the core temperature of the patient to 31 degrees Celsius after a patient has been resuscitated in order to minimize neurological damage. Mark Adams, program coordinator of the therapeutic temperature management program, has been using this technique for years at the UHS. Adams said the target of this procedure is not the heart, but the brain.
“You can get a pulse back, you can get the heart beating, but if the brain has sustained a degree of injury — that injury continues for hours and days,” Adams said. “It’s not like once blood flow is reestablished everything is well. There are over 30 different pathways — neurochemical pathways — that have been discovered... and the cooling stops many of them and slows many more so the brain tissue that’s at risk does not get destroyed.”
Two methods can be employed to reduce the core body temperature of patients. The first technique involves administering cold saline in combination with cooling blankets and cold packs. The other more invasive way to lower the body temperature uses an IV line and catheter that cools the blood and thereby chills the body through circulation.
While this procedure improves chances of survival, not all patients qualify as suitable candidates for this procedure. The primary criterion for candidates is that the cardiac arrest is the result of a heart-related issue that can be treated rapidly.
Cardiac arrest due to other diseases or traumas such as stroke or a car accident preclude patients from being candidates for this therapy.
Emergency Medicine Prof. Dr. William Brady noted the significant impact of the use of targeted temperature management resulted from a change in the timeline of prognostic determinations — the assessments made by physicians regarding the condition of patients.
“Prognostic determinations would be made in the first 24 hours prior to us having and using therapeutic hypothermia,” Brady said. “But now that we have therapeutic hypothermia … we need to chill [patients] for at least 24 hours, and any determination of survival and other issues needs to be delayed until the targeted temperature management has been completed and the patient is allowed to wake up if they are going to wake up.”
Targeted temperature management has moved the prognosis determination to 48 hours after resuscitation and improved survival rates. The survival rate over the past few years for patients in this program has ranged from 28 to 35 percent, with three-quarters of the survivors resuming normal day-to-day activities.
“I’ve been here 20 years and for the first nine years of my career as a bedside nurse, I don’t recall but one patient leaving the Coronary Care unit alive following their cardiac arrest admission,” Adams said. “Now we’re sending multiple patients home a year who have benefitted from this therapy.”
However, Brady acknowledges that the improvement in survivorship and in effectiveness of targeted temperature management needs to be taken with a grain of salt.
“[Targeted temperature management] is a very important tool and it does have significant positive impact, but not everybody that’s a cardiac arrest survivor is a candidate and not everyone that is a candidate will survive because of its use,” Brady said. “It has increased the survival rate, but it’s not a magic treatment.”
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