Resuscitation science is getting really cool

Although applied hypothermia following resuscitation from cardiac arrest is supported by robust evidence it is not likely to be given high priority by hospital administrators any time soon, since it is not a performance measure and the designation of regional resuscitation centers has not yet hit prime time.

A recent article from Today's Hospitalist deals with practical aspects of therapeutic hypothermia and the role of hospitalists. There are many institutional barriers to implementation. Lack of organization, distraction by performance measures (which are all some administrative types seem to think they're accountable for), uncertainty as to who should “own it”, and perceived difficulties and expense (it doesn't have to be that expensive) are to blame.

Once you get past the barriers the protocol itself is fairly easy. The hard part comes in assessing neurologic prognosis. That's much more difficult in the hypothermia era. The evolution of neurologic changes slows down and prognostic assessments must generally be made later:

Chicago’s Dr. Edelson echoes that assessment. "Hypothermia slows everything down," she says, making it harder to tell early on who is going to wake up. "We may need to extend the observation period following successful resuscitation before determining futility and withdrawing care." That observation period may potentially be as long as five days, she explains, "or it might be longer. But it is becoming clear that patients treated with hypothermia are waking up later than we are used to."

...hypothermia has thrown a wrench into that timeline. If the important exam is at 72 hours, is that post-arrest or after the patient has been re-warmed? Dr. Josephson said that research is needed to answer that question. He also noted that it is important to keep reexamining the patient.

And who's the most effective champion for hypothermia? Maybe it's the fire chief:

A number of major U.S. cities—including New York, Miami and Boston—now require ambulances to transport cardiac arrest patients only to hospitals with hypothermia capabilities.