Authors

• Gorana Spitek — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-4797-5342
• Danijela Sorić-Noršić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-2278-7241
• Vesna Vlahek — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-5459-2238
• Maja Šipek — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-1449-0250

Keywords

cardiac arrest, therapeutic hypothermia

DOI

Full Text

Cardiac arrest is the leading cause of death in developed countries. (1) Particularly poor prognosis are for patients who experience cardiac arrest outside the hospital, where the hypoxic brain damage is crucial in the development of irreversible neurological complications and may lead to death. In patients who experienced cardiac arrest outside the hospital due to ventricular fibrillation or ventricular tachycardia, and after admission to the hospital were in an unconscious state, ILCOR (International Liaison Committe on Resuscitation) recommends therapeutic use of hypothermia. The role of nurses in the care of patients on whom therapeutic hypothermia is performed is crucial. In addition to the implementation of health care interventions and delegated interventions from other members of the multidisciplinary team, the nurse must monitor the incidence of symptoms and signs of possible side effects that hypothermia can cause. Possible side effects are: tendency for arrhythmias, occurrence of pulmonary edema, hypotension, disorders of hemostasis (increased tendency to bleed). Basic contraindications for therapeutic use of hypothermia are: coma of other etiology, refractory hypotension despite inotropic support and volume compensation, sepsis, hemodynamically unstable arrhythmias, pregnancy and terminal illness, known coagulopathy and active bleeding, a major surgery within 14 days. When therapeutic hypothermia is performed, the application of fibrinolysis and percutaneous coronary intervention are not contraindicated. Body temperature is measured by a rectal thermometer or a special probe in the bladder, and the target temperature is from 32-34° C. The target temperature is achieved by infusion of cold saline solution or Ringer’s lactate cooled to 4° C or coating patients with ice packs (armpits, groin, neck,). Recently, devices for invasive implementation of therapeutic hypothermia are available. The target temperature is achieved during 6-8 hours and maintained for the next 24 hours. The whole time the patient must be sedated and relaxed. After 24 hours, with further maintenance of sedation and relaxation of the patient, passive warming begins to raise body temperature to 36° C which is achieved in 6 hours. This case report will be present the course of recovery of one patient, with an emphasis on the complexity and demands of healthcare for the role of nurses in caring for patients therapeutic hypothermia is performed on.

Literature

1. Patel PV, John S, Garg RK, Temes RE, Bleck TP, Prabhakaran S. Hypothermia After Cardiac Arrest is Underutilized in the United States. Ther Hypothermia Temp Manag. 2011;1(4):199–203. https://doi.org/10.1089/ther.2011.0015