Department of Intensive Care Medicine, St George's Hospital, London, Tooting, London SW17 0QT, UK.
Resuscitation. 2012 Feb;83(2):151-8. doi: 10.1016/j.resuscitation.2011.10.002. Epub 2011 Oct 14.
Out of hospital cardiac arrest (OHCA) results in a significant mortality and neurological disability in survivors. The application of mild therapeutic hypothermia (MTH) to patients who have suffered an OHCA with a ventricular rhythm results in a significant reduction in mortality and neurological disability in survivors. The optimal timing of this intervention has not been clearly established; however there is emerging evidence to suggest that maximal benefit is gained from initiation at the earliest time point. Despite this, recent surveys have shown a considerable delay in initiating MTH, with variable uptake in emergency departments (EDs), where a number of impediments to delivery have been identified.
We have reviewed the literature to determine what are the barriers to the initiation of MTH in the ED. We also reviewed the literature on the use of ice-cold crystalloids as a practical, simple, effective, and safe method to induce MTH.
Among the several reasons, the perception of a lack of a practical method and logistical constraints are cited as common barriers. However, the available literature on the use of ice-cold crystalloids suggests that this is a safe and effective method of inducing MTH.
ED staff need to be aware that the use of ice-cold fluids is an inexpensive, readily available and easy to perform method of inducing MTH in patients who suffer an out-of hospital cardiac arrest with a ventricular rhythm. We therefore suggest that ice-cold crystalloid is routinely stocked in emergency departments and, unless contraindicated, is used to induce MTH. Optimal post-resuscitation care also includes timely treatment of the cause of the OHCA and maintenance of MTH. Staff education and care bundles may help to facilitate optimal inter-departmental management of the patient.
院外心脏骤停（OHCA）可导致幸存者死亡率和神经功能障碍显著增加。对室性节律 OHCA 患者应用轻度治疗性低体温（MTH）可显著降低死亡率和幸存者的神经功能障碍。该干预措施的最佳时机尚未明确；然而，有新的证据表明，尽早开始干预可获得最大获益。尽管如此，最近的调查显示，开始 MTH 的时间明显延迟，急诊科（ED）的采用率也存在差异，其中已经确定了一些实施障碍。
我们回顾了文献，以确定 ED 中启动 MTH 的障碍有哪些。我们还回顾了关于使用冰冷晶体作为一种实用、简单、有效且安全的诱导 MTH 方法的文献。
在诸多原因中，缺乏实用方法和后勤方面的限制被认为是常见的障碍。然而，关于使用冰冷晶体的现有文献表明，这是一种诱导 MTH 的安全有效方法。
ED 工作人员需要意识到，在发生室性节律 OHCA 的患者中，使用冰冷液体是一种廉价、易得且易于实施的诱导 MTH 的方法。因此，我们建议在急诊科常规储备冰冷晶体，并在无禁忌证的情况下使用其诱导 MTH。最佳复苏后护理还包括及时治疗 OHCA 的病因和维持 MTH。员工教育和护理包可能有助于促进患者跨部门的最佳管理。
