201 0 Miracle on Ice Conference Minneapolis Heart Institute at Abbott Northwestern Hospital
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1 Miracle on Ice 2010 :Therapeutic Hypothermia for Cardiac Arrest Patients Sept 9 10, 2010 Allina Commons Midtown Exchange Minneapolis, Minnesota Course Directors: Barbara Tate Unger RN, BS,FAACVPR,FAHA Mike Mooney MD, FACC,FSCAI, FAHA Minneapolis Heart Abbott Northwestern Hospital Miracle on Ice Therapeutic Hypothermia Conference December 2009 Minneapolis Heart Institute at Abbott Northwestern Hospital Miracle on Ice Therapeutic Hypothermia Conference September 2010
2 Miracle on Ice Conference Planning Committee Christine Bent COO Minneapolis Heart Institute at Abbott Northwestern Hospital Jackie Boucher MS RD CDE VP, Education, Minneapolis Heart Institute Foundation Kevin Graham MD FACC President Minneapolis Heart Institute at Abbott Northwestern Hospital J Eva Kovacs MBA Professional Education Manager, Minneapolis Heart Institute Foundation Michael Mooney, MD, FACC, FSCAI,FAHA, Interventional Cardiologist, Co Director Cardiovascular Labs, Director Coolit Program, Minneapolis Heart Institute Monique Ross RN BSN, PHN Cardiovascular Emergency Program Manager, Minneapolis Heart Institute at Abbott Northwestern Hospital Barbara Tate Unger RN BS FAHA FAACVPR, Development Director, Systems of Cardiovascular Emergency Care, Minneapolis Heart Institute at Abbott Northwestern Hospital Faculty Miracle On Ice 2010 Graham Nichols MD Scott Sharkey MD David Seder MD Paul McMullan MD John McPherson MD Nainesh C. Patel MD Sue Sendelbach RN PhD Nader Moazami MD Barbara Tate Unger RN William Katsiyiannis MD Michael Mooney MD
3 Conference objectives 1. Describe the current state of resuscitation, treatment, and outcomes from the national perspective 2. Develop a protocol to intimate and maintain mild hypothermia for the patient that remains comatose following a cardiac arrest List patient selection inclusion/exclusion criteria for therapeutic hypothermia 4. Describe the simultaneous application of treatments for a patient with STEMI who has suffered a cardiac arrest without regaining consciousness 5. Explain the homodynamic changes that occur during hypothermia and treatment 6. Evaluate the frequency of cardiogenic shock and the treatment during TH 7. Identify cardiac arrhythmias that occur during hypothermia and treatment protocols for those arrhythmias 8. Collect data to measure clinical outcomes and respond with process improvement. Updated conference stats 19 different state are represented 1 returning attendee from last year 46 different hospitals 5 EMS units
4 Statement of public health needs Hypothermia The Year in Review New Technology Randomized trials RICH Bernard Rapid MI-ICE ICE Gotberg,Lund SW Prince BeneChill New Registries i North American Intcar, Uof Penn New Systems of Care
5 Life Recovery Systems ThermoSuit LRC Cooling Rates
6 Xenon Pediatric Neuroprotection Intravascular Cooling InnerCool - Phillips
7 Rapid MI-ICE ICE study summary 20 pts w/ STEMI randomized iced saline and intravascular cooling v. control (Innercool Innercool) Core temp <35 in 40 min D2B 43 min 1500 cc 4 deg. Saline. Demerol, busperone Day 4 cmri T2 v. Gadolinium Troponin T elution curves No difference in clinical outcomes Rapid MI-ICE Study - Lund,Sweden (Gotberg, Olivecrona ) A Pilot Study of Rapid Cooling by Cold Saline and Endovascular Cooling Before Reperfusion in Patients With ST-Elevation Myocardial Infarction Circ Cardiovasc Interv published online Aug 24, 2010
8 Rapid MI-ICE ICE Study - Lund,Sweden (Gotberg, Olivecrona ) Troponin Elution Curves EKG Hypothermia Osborne Waves
9 Lung PFC Cooling L Becker Regional Cooling
10 BeneChill Design Concept RhinoChill cooling device Castren, M. et al. Circulation 2010;122: Copyright 2010 American Heart Association
![Circulation 2010;122:729-736 Copyright 2010 American Heart Association Rates of neurologically intact survival (defined as having a cerebral performance category [CPC] of 1 or 2) in the treatment and](/docs-images/77/75416755/images/11-1.jpg "control groups among those patients admitted to the hospital for the entire group, those who received rescuer CPR within 10 minutes, and those with a presenting rhythm of VF Castren, M. et al.")
11 Intra-Arrest Transnasal Evaporative Cooling: A Randomized, Prehospital, Multicenter Study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness) Time to target temperature (core) of 34{degrees}C in minutes (median) from the cardiac arrest in the treatment and control groups among those patients admitted to the hospital Castren, M. et al. Circulation 2010;122: Copyright 2010 American Heart Association Rates of neurologically intact survival (defined as having a cerebral performance category [CPC] of 1 or 2) in the treatment and control groups among those patients admitted to the hospital for the entire group, those who received rescuer CPR within 10 minutes, and those with a presenting rhythm of VF Castren, M. et al. Circulation 2010;122: Copyright 2010 American Heart Association
12 RICH - Trial profile 6% VF w/ ROSC Bernard, S. A. et al. Circulation 2010;122: Copyright 2010 American Heart Association Temperatures of all patients Bernard, S. A. et al. Circulation 2010;122: Copyright 2010 American Heart Association
13 Discharge outcome Results RICH Trial Paramedic Cooling (n=118) Hospital Cooling (n=116) P * Favorable outcome, n 56 (47.5; ) 61 (52.6; ) (%; 95% CI) Discharge to home, n (%; 95% CI) Discharge to rehabilitation, n (%; 95% CI) Discharge to nursing home awake, n Discharge to nursing home comatose, n (%; 95% CI) 24 (20.3; ) 34 (29.3; ) (27.1; ) 27 (23.3; ) (0.9; )... Dead, n (%; 95% CI) 62 (52.5; ) 54 (46.6; )... CI indicates confidence interval. *P calculated by 2 test. Induction of Therapeutic Hypothermia by Paramedics After Resuscitation From Out-of-Hospital Ventricular Fibrillation Cardiac Arrest: A Randomized Controlled Trial Stephen A. Bernard, Karen Smith, Peter Cameron, Kevin Masci, David M. Taylor, D. James Cooper, Anne-Maree Kelly, William Silvester for the Rapid Infusion of Cold Hartmanns (RICH) Investigators Circulation : New Insights Response Team Reduces Rate of Cardiac Arrests: Hospital'Code Blue' emergencies at VA center declined 57 percent in first two years cardiac arrests decreased 57 percent, from an average of 10.1 to 4.36 cardiac arrests per 1,000 patients overall death rate decreased 17 percent Systems of care can also be in hospital Palo Alto VAH Anesthesia & Analgesia, Aug. 26, 2010
14 Neuro-cognitive recovery team
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