For many decades, significant information has been identified that describes the use(s) of post-cardiac arrest hypothermia. There are also numerous clinical reports of patients with prolonged cardiac arrest with unexpected survival after experiencing acute hypothermia.
Two famous cases have captivated the world’s attention.
A female Scandinavian physician fell through the ice while cross-country skiing and was trapped. After a prolonged immersion, she was transported by helicopter to a regional hospital. Upon arrival, she was rewarmed after more than 2 hours of pulselessness. She was successfully resuscitated and went on to continue her medical practice.
The other was the case of a young boy who fell into the ice-covered Lake Michigan in Chicago. It took divers over 45 minutes to retrieve him from the water and another 25 minutes to arrive at Weiss Memorial Hospital. The CPR and rewarming techniques were continued for almost one hour, which resulted in a return of spontaneous circulation. Jimmy Tonkowitz was interviewed for television on the 10th anniversary of that day.
As far back as 2005, retrospective surveys of physicians chosen at random have been questioned about their use of therapeutic hypothermia. The surveys sought to identify modalities used and reasons why hyperthermia was not part of their care of arrested patients. One survey queried 265 physicians practicing in the specialties of cardiology, emergency medicine, and critical care. Eighty-seven percent of these practitioners said that they had not used hypothermia. The reasons given included inadequate data to support its use, lack of ACLS protocols, and many expressed that induced hypothermic techniques were too clinically difficult and probably too slow.
It appears that even though substantial data exists supporting the use of post-arrest hypothermia, it has not become widely used in practice.
For information on a protocol developed at the University of Pennsylvania, click here.
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