GCRAC “ICE” PROPOSAL

(Induced Cooling by EMS)

By : Walter Morrow

PHI Air Medical

The Idea of “ICE”

• Sudden Cardiac Death– Out of hospital cardiac arrest is a common disease

• 600-1000 Americans have a OOHCA daily• 47% never make it to the hospital• CHANCE OF SURVIVAL 1:20

The Idea of “ICE”

• There has been no significant decline over the past few decades despite advances in medications and early defibrillation

• Return Of Spontaneous Circulation (ROSC)– Many pt’s continue to have poor outcomes after

hospitalization– Neurologic impairment often remains a lasting

morbidity

The Idea of “ICE”

• Causes of Death in ROSC pt’s– 10% refractory dysrhythmias– 30% poor cardiac output states– 40% post resuscitation encephalopathy

• (neurologic injury) • Caused by cell death (multiple factors)

Idea of “ICE”

• Induced hypothermia is considered a Class IIA procedure according to the AHA.

• Epi is considered a Class IIB

Success: Bernard Study Group

RISK : BENEFIT

Outcome Hypot. (N=43) Normot. (N=34)

Normal or minimal disability (discharged directly home)

15 7

Moderate Disability (to rehab facility) 6 2

Severe Disability but awake (long term Nsg facility)

0 1

Severe Disability, unconscious (long term Nsg facility)

0 1

Death 22 23

NOTE: “bad” outcomes = 13% for hypot vs 17% for normo

The Idea of “ICE”

• Induce hypothermia in ROSC pt’s to bring pt temperature down to the 32-34 degree Celsius range (89.6-93.2 degree F)

• Bolus of cooled normal saline • Ice pack application

GCRAC “ICE” GOALS

• Improve outcomes of post cardiac arrest patients .

• Comply with AHA’s ECC current guidelines (2005)

• Lead the south Texas in advanced cardiac care

• Promote awareness of GCRAC, Hospitals and local EMS services

Sample Protocol

“ICE” Plan

• EMS support • Hospital Support (with cardiac services)

– DeTar Hospital and Citizen’s Medical Center are on both on board

– Community Hospitals to follow EMS plan

• GCRAC support

GCRAC

• Request GCRAC to purchase cooling units for primary response ambulances in RAC.

• Develop RAC wide protocols for both EMS and hospitals.

• Provide oversight of program through the Acute Care Committee

Training of EMS

• PHI Air Medical has offered to provide the hypothermia training to all EMS agencies at no cost.

Costs

• Cooling units – GCRAC funding?• Normal Saline – EMS units / Hospital • Ice Packs – EMS Units / Hospital• Training

– Class is provided by PHI Air Medical– Staff payment during training – EMS agency /

Hospital

Cooling Units

• Refrigerators – Cost effective– Very large – space limited– Hard to secure in ambulance

• Cooling Units – designed for EMS use– Chillcore case by Thomas EMS– Engle EMS Unit cooler by Engle USA

Engle EMS Unit

• Some what mobile• Requires mounting hardware• Requires thermometer• Adjust temperature using dial like home fridge• Lower cost $600

Chillcore Case

• Mobile • Cools at constant temp

– As low as 20 degrees C

• Battery pack• 12V or 110V• Cost $799

GCRAC Staffed EMS Units

• Victoria FD 4• Calhoun Co EMS 3• Edna EMS 2• Ganado EMS / Jackson Co ESD ?• Yoakum EMS 2• Lavaca Co. Rescue 2• Cuero EMS 2• Goliad EMS 2• Yorktown EMS? (BLS service) ?• PHI Air Medical 0

Total 17-20 units

Costs

• Chillcore Unit• 17-20 x $799 = $13583 - $15980

• Engel EMS Unit• 17-20 x $600 = $10200 - $12000

Thank you for your time!

Find out more info at:

JEMS online web casts

MCHD EMS – hypothermia

Wake Co. EMS