FRENCH HOSPITAL
MEDICAL CENTER
POLICIES & PROCEDURES
Title: Therapeutic Hypothermia
Section: Clinical
Dept of Origin:
Dept of Dist:
ICU
ED, ICU, Cath Lab
Reviewed/Revised:
Approved:
9/07, 04/10, 1/12
PREAMBLE:
The Dignity Health facilities of the Central Coast develop and implement policies that seek to encompass our
mission statement and core service values of Dignity, Stewardship, Justice, Collaboration, and Excellence in our
daily service. Our policies guide us in supporting this ministry of providing quality, compassionate services.
POLICY: Therapeutic Hypothermia will be defined as the early recognition and prompt intervention and
treatment after the return of spontaneous circulation (ROSC) post cardiac arrest. Utilizing the
multidisciplinary team approach, appropriate resources and equipment will be provided for the patient
meeting criteria.
Relative Inclusion Criteria:
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Non Traumatic Cardiac Arrest with ROSC
Core Temperature > 33° Celsius at presentation
Time to initiation of therapeutic hypothermia is less than 6 hours
Comatose after ROSC: GCS less than 8, and no purposeful response to pain
May consider for other indications:
 hanging as suspected cause of cardiac arrest
 malignant hyperthermia
Relative Exclusion Criteria:
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Conflict with Advanced Medical Directives or DNR status
Uncontrolled Bleeding (Absolute Contraindication)
Cardiovascular instability as evidenced by: Uncontrollable arrhythmias
Refractory hypotension (unable to achieve MAP of 60 mmHg despite interventions)
Sepsis or other cause (as suspected cause of cardiac arrest)
Suspected intracranial hemorrhage
Major intracranial, intrathoracic, or intrabdominal surgery in past 14 days
IVC filters (placement of intravascular cooling catheter should be IJ or subclavian NOT
femoral if patient has an IVC filter)
PURPOSE: To provide guidelines for the application of mild therapeutic hypothermia to
comatose survivors of cardiac arrest in an attempt to improve mortality and neurological
outcomes.
BACKGROUND: Brain temperature during the first 24 hours following resuscitation from
cardiac arrest may have a significant effect on survival and neurological recovery. Cooling to 3234°Celsius for 24 hours may decrease the chance of death and increase the chance of
neurological recovery.
Page 1 of 4
FRENCH HOSPITAL
MEDICAL CENTER
POLICIES & PROCEDURES
Title: Therapeutic Hypothermia
Section: Clinical
Dept of Origin:
Dept of Dist:
ICU
ED, ICU, Cath Lab
Reviewed/Revised:
Approved:
9/07, 04/10, 1/12
EQUIPMENT:
 External cooling (Blanketrol III) machine is stored in ED and equipment storage room on
Telemetry Unit.
 Surface cooling vests, head wraps, and blankets are stored in ED, ICU, and Materials
Management
 Intravascular cooling (Alsius/Zoll Coolgard) machine is stored in the ICU.
 Foley and rectal probe cables (DO NOT DISPOSE) are stored with machine.
 Temperature sensing foley catheters and rectal probes are stored in Cath Lab, ICU, and
Materials Management.
 Intravascular cooling catheters (Cool Line, Icy, and Quattro) are stored in the Cath Lab.
 Alsius/Zoll Start Up kit are stored in the ICU.
 500ml bag normal saline available in Omni-cell.
 Re-usable equipment will be cleansed after each patient use and per Equipment, Patient Care
Item Policy.
PROCEDURE:
PROCEDURE for Cold Saline Infusion:
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If core temperature is > 33°Celsius at initiation of protocol
Bolus with cold (4°C / 39°F) of 0.9% NS (available in Emergency Department / Cath
Lab) @ 30ml/kg over 30-60 minutes with a maximum of 2 liters total. This is NOT to be
given via jugular or subclavian line; a peripheral or femoral line must be used.
PROCEDURE for External Cooling:
Obtain device and apply cooling blanket and/or vest to patient’s head, torso, and limbs.
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Insert temperature sensing device (foley, rectal, or esophageal probe)
Set target temperature at 32°-34°C for 24 hours
Observe skin every 2 hours for signs of breakdown
*In cath lab/ED, may utilize ice packs (neck, axilla, and groin) to initially achieve
cooling if blanket unavailable.
Monitor labs/diagnostics as directed
PROCEDURE for Intravascular Cooling: Insert intravascular cooling catheter (Alsius) and
connect to unit.
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Equipment:
Intravascular cooling catheter (see below for placement and dwell times for each)
Intravascular cooling start up kit (contains tubing and coil)
500 ml bag of NS
Page 2 of 4
Title: Therapeutic Hypothermia
Section: Clinical
Dept of Origin:
Dept of Dist:
ICU
ED, ICU, Cath Lab
Reviewed/Revised:
Approved:
FRENCH HOSPITAL
MEDICAL CENTER
9/07, 04/10, 1/12
POLICIES & PROCEDURES
Catheter Name
Model Number
Number of Heat Exchange Balloons
Number of Infusion Lumens
Insertion Site
Outer Diameter at Insertion Site
Length
Flow Rate (ml/hr) **
Distal
Proximal
Medial
Dwell Time of Catheter
Cool Line
CL-2295
2
3
Subclavian
Internal Jugular
Femoral
9.3F
22cm
Icy
IC-3893
3
3
Femoral
Quattro
IC-4593
4
3
Femoral
9.3F
38cm
9.3F
45cm
2200
1400
1400
7 days
1900
1300
1000
4 days
1900
1300
1000
4 days
** DO NOT USE POWER INJECTOR with intravascular cooling catheter**
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Check coolant level (additional coolant or distilled H2O in Biomed)
Power on (follow prompts for system set up)
Set target temperature at 33°C and rate as max (default) for 24 hours
Open start up kit and place coil into coolant
Secure coldwell lid and put air trap in its holder
Open lid of roller pump
Undo tubing bundle containing the spike. The largest section of tubing goes into the
roller pump
Manually rotate the pump to 11 o’clock position to facilitate loading of tubing
Load tubing into pump (side of tubing with flange fits into the slot on the right side of the
roller pump
After spiking saline bag, lift out the air trap from its holder and turn it upside down.
Press and hold the PRIME switch until the air trap and tubing are completely full of
saline (approximately 2 minutes)
Insert primary (temperature sensing foley catheter) and secondary (rectal or esophageal
probe) temperature sensing device and connect to device.
Monitor labs/diagnostics as directed
PROCEDURE for Re-WARMING:
If EXTERNAL Cooling utilized:
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Remove cool packs and blankets
May apply warm blanket (do NOT use device to re-warm)
Page 3 of 4
Title: Therapeutic Hypothermia
Section: Clinical
Dept of Origin:
Dept of Dist:
ICU
ED, ICU, Cath Lab
Reviewed/Revised:
Approved:
FRENCH HOSPITAL
MEDICAL CENTER
9/07, 04/10, 1/12
POLICIES & PROCEDURES
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Monitor labs/diagnostics as directed
If INTRAVASCULAR Cooling utilized:
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Set target temperature at 36°C and re-warming rate at 0.25°C/hour
Monitor labs/diagnostics as directed
PROCEDURE for Intravascular Catheter Removal:
 RN or Physician may remove
 Use 10ml syringe to port and deflate balloons (leave port open once deflated)
 Manually remove venous line (may note some bumpy traction at balloon sites as line is
removed)
 Hold manual pressure or utilize femo-stop as indicated to obtain hemostasis
References:
1) Advanced Life Support Task Force of the International Liaison Committee on Resuscitation (2003).
Therapeutic Hypothermia after Cardiac Arrest. Circulation; 108: 118-121. Doll: 103.1016/j.
resuscitation.2007.04.015
2) American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular
Care (2005) Circulation; 112:24.
3) Bernard, Stephen (2006). Therapeutics Hypothermia after Cardiac Arrest. Neurological Clinics; Vol24,
No.1
4) Hypothermia after Cardiac Arrest Study Group (2002). Mild Hypothermia to Improve Neurological
Outcomes after Cardiac Arrest. NEJM: 346:549-556
5) Stiell I.G., Wells, G.A. et.al. Advanced Cardiac Life Support in Out of Hospital Cardiac Arrest (2004).
NEJM; 351:7:647-656
6) Society of Critical Care Clinical Focus Conference: Hypothermia: Keeping It Cool – How to Implement
Hypothermia in Your Clinical Practice; April 2010; Pasadena, CA
7) Neurocritical Care [abstract] 2007; 6:228
8) Zoll Circulation: Thermogard XP/Coolgard 3000 Operation Manual , 2009
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