Hospitals in pursuit of excellence

The Cool-It Program: Preventing Brain Injuries and Death

The Problem

Standard care for a patient in cardiac arrest has been cardiopulmonary resuscitation, followed by cardiac defibrillation if available, and transport to the nearest hospital where the patient is stabilized. A patient in cardiac arrest arriving at Queen of Peace Hospital is stabilized and then transferred to Abbott Northwestern Hospital in Minneapolis. During the transfer time, which could be 30 to 45 minutes, permanent brain injury to the patient or death can occur.

The Solution

The medical field once thought that irreversible brain injury would occur in patients during the first six minutes of cardiac arrest. Now practitioners know that during those first six minutes a chain of events begins that could ultimately lead to brain death. But this chain of events can be interrupted using resuscitation and defibrillation followed by therapeutic hypothermia, preserving brain function from 6 minutes to about 45 minutes after cardiac arrest.

Collaborating with Abbott Northwestern Hospital, Queen of Peace implemented the "Cool It" program to induce therapeutic hypothermia in patients experiencing cardiac arrest. By inducing hypothermia, a patient's core temperature is reduced to 33 degrees Celsius from 37 degrees Celsius. This process slows the body's metabolism, decreases oxygen consumption, and thus preserves brain function.

When patients in cardiac arrest arrive at Queen of Peace, they are sedated if they are not already unconscious. Nurses apply ice packs to the abdomen, chest, and under the patient's arms, while physicians are working on the patient. Patients are readied for the transfer and flight to Abbot Northwestern. The flight is about 10 minutes, but the entire preparation process takes about 30 to 40 minutes. Once at Abbott Northwestern, the cooling process continues.

Candidates for the program must meet certain criteria, for example have "downtime" of less than 45 minutes—ideally less than 30 minutes—and have had nontraumatic cardiac arrest with spontaneous return of circulation and a steady heart rhythm.