Clinical Pathway for the Care of Children Post-CPR

Induced Hypothermia
Definition: 32-34°C
arrow
Measure Patient
Core Temperature
Use 2 core probes according to the following preferences:
  1. Esophageal
  2. Foley
  3. Rectal
Use Cooling Blanket Order Set
arrow
arrow
arrow
arrow
arrow
arrow
arrow
arrow
arrow
arrow
Patient Core
Temperature < 30°C
Patient Core
Temperature ≥ 30°C
Set Blanket Temperature
MANUAL 42°C
arrow
Set Blanket Temperature
AUTOMATIC 33°C
Core Temperature ≥ 30°C
Set Blanket Temperature
AUTOMATIC 33°C
Core Temperature Goal
32-34°C
arrow
arrow
arrow
arrow
arrow
arrow
arrow
arrow
arrow
Maintenance Phase
Maintain Goal Temperature for 48 hours
Rewarming
arrow
Increase Blanket Temperature
1°C every 6 hours in gradient 10 smart mode to goal of set temp 36.8°C
arrow
HYPOTHERMIA – WHAT TO EXPECT
Sinus Bradycardia No intervention needed if end organ perfusion maintained
(nl SVO2/lactate)
Hypertension, Poor Peripheral Perfusion, Low Mg, CA, Phos, K Add K to fluids if making urine
Replete others as needed
Cold Diuresis Monitor CVP and replete fluids as needed
Hyperglycemia May need insulin
Shivering Sedate, paralyze as needed
Increase in Bleeding Time Usually no significant bleeding complications
< 30°C HIGH RISK VF
REWARMING – WHAT TO WATCH FOR
Vasodilation with:
  • Associated tachycardia
  • Hypotension
  • Low urine output
Replete fluids as needed
Monitor CVP and end organ perfusion
Hyperkalemia Consider decreasing supplemental potassium
Shivering Sedate and paralyze as needed