Therapeutic hypothermia (TH) has become standard in the care of patients with return of spontaneous circulation from cardiac arrest. Although the optimal duration of TH is unknown, current literature supports 12-24 hours of cooling to 32-34oC. As many of our critically ill patients remain in the ED for seemingly endless lengths of stay, it is likely that most emergency physicians will be managing patients with TH during the maintenance phase of cooling. Some pearls regarding the maintenance phase:
Metabolic and hemodynamic homeostasis is critical
Target volume-cycled mechanical ventilation to maintain a normal pH
Maintain a MAP > 65 mm Hg
Maintain blood glucose between 120 - 160 mg/dL
Frequently check and aggressively replete potassium, magnesium, and phospate
References
Seder DB, Van der Kloot TE. Methods of cooling: Practical aspects of therapeutic temperature management. Crit Care Med 2009;37:S211-22.
