Updates from the Field

Cooling patients with severe TBI in China
Clinicians in China have been cooling patients with severe traumatic brain injury since the 1950s and continue to find success with using mild-to-moderate hypothermia for five days, reported Ji-Yao Jiang in Therapeutic Hypothermia and Temperature Management. Jiang explained the longer period of cooling differs from treatments in the United States, where cooling is limited to 24-48 hours. However, that shorter hypothermic period often results in a rebound increase in intracranial pressure. Jiang’s research has found the longer, five-day cooling, does not result in rebound intracranial hypertension. Those patients treated with the longer mild hypothermia also experienced improved outcomes. Jiang cautioned that mild hypothermia is not appropriate for all severe traumatic brain injured patients, only those with diffuse cerebral contusion and refractory intracranial hypertension. Additionally, more training of Chinese nurses is needed to prevent complications, including pneumonia.  More>>

Cooling benefits asphyxiated newborns
Starting therapeutic hypothermia on newborns with perinatal asphyxia within three hours of birth is safe and improved infants’ motor outcomes, according to researchers from the University of Bristol in the United Kingdom. The team studied 80 cooled newborns, 43 cooled within three hours and 37 started more than three hours post-birth. Sixty-five newborns survived, 35 receiving the therapeutic hypothermia early and 30 late. Among survivors, psychomotor development was significantly better in those infants cooled early, compared to those receiving the treatment later. They detected no significant difference in mental development. The authors concluded in Neonatology that “cooling should be initiated as soon as possible after birth in eligible infants.”   More>>

Vanderbilt Institute participating in VELOCITY study
Vanderbilt Heart and Vascular Institute in Nashville, Tenn., is one of six North American institutions participating in the randomized controlled VELOCITY study to evaluate the safety and feasibility of rapidly cooling patients suffering a ST-segment elevation myocardial infarction. Vanderbilt has begun enrolling patients, who will either receive a percutaneous coronary intervention (PCI), the current standard, or will be rapidly cooled and then receive the PCI. The first patient given the cooling therapy at Vanderbilt did well, said treating physician Peter Fong, MD, an interventional cardiologist. The trial is open to patients age 18-85 years, arriving at Vanderbilt within six hours of symptoms starting, with no history of a prior myocardial infarction, and meeting other criteria.  More>>

NASA considers cooling astronauts headed to Mars
Hypothermic torpor is one idea NASA is considering in its plans for a manned Mars space flight. The astronauts would, in essence, hibernate during the six months it takes to travel to Mars. NASA may induce hibernating through therapeutic hypothermia, reducing the astronauts’ body temperatures to decrease the amount of energy consumed. Dropping the body temperature 10 degrees would result in a 50% to 70% decrease in metabolic rate. The astronauts would require ventilator support and IV nutrition. NASA would induce the hypothermia by allowing the spaceship to drop its temperature as it travels through freezing-cold space. NASA still needs to work out many details, including how to prevent bone loss and muscle atrophy. More>>

Recooling a patient question posed to Arctic Challenge
A website reader from the University of Pennsylvania in Philadelphia queried the “Arctic Challenge” about recooling a patient who experiences a subsequent cardiac arrest. Mary McKenna Guanci, MSN, RN, CNRN, a clinical nurse specialist at Massachusetts General Hospital in Boston responded that evidence is lacking but asked physicians and nurses at several large academic medical centers. She found that “most clinicians agreed that if prognosis was uncertain and the reinduction carried more benefit than risk, they would recommend therapeutic hypothermia be instituted once again following the hospital’s standard guideline.” An opportunity for research in this area clearly exists. More>>

Study will assess EMS initiating cooling in cardiac arrest cases
Sunnybrook Health Sciences Centre in Toronto, Canada, continues enrolling participants in the “Initiation of Cooling by EMS to Promote Adoption of In-hospital Hypothermia in Cardiac Arrest Survivors” randomized controlled trial, comparing pre-hospital initiation of therapeutic hypothermia by emergency medical services (EMS) providers to conventional post-resuscitation care. The trial’s goal is to increase the proportion of cardiac arrest patients that are appropriately treated in-hospital with therapeutic hypothermia to reach the target body temperature within six hours of hospital arrival. The investigators believe that EMS-initiation of cooling will be a powerful reminder to in-hospital clinicians to continue therapeutic hypothermia, and will lead to care improvements across a health system. The investigators plan to enroll 900 people in the study by December 2016. The primary outcome is the proportion of included patients that are successfully cooled to reach target temperature of 32 to 34 degrees Celsius within six hours of emergency department arrival. More>>

Grant allows expansion of EMS cold therapy
A $2,110 grant from the Pocono Health Foundation to Pike County Advanced Life Support (PCALS) will enable the nonprofit paramedic service, serving Pike and Wayne Counties in Pennsylvania, to expand its Induced Therapeutic Hypothermia Program, with an additional two cooling units. The paramedics begin cooling appropriate patients before reaching the hospital. The foundation awards the Dr. Claus G. Jordan Endowment Grant each year to innovative community health outreach programs and physician leadership initiatives. PCALS President Mary Lou Corbett reported that the organization has had several success stories in the past few years in using this treatment. More>>

Cooling rarely used after in-hospital cardiac arrest
A multicenter, prospective cohort study, involving 538 U.S. hospitals participating in the Get With the Guidelines-Resuscitation database, found that “therapeutic hypothermia was used rarely” following in-hospital cardiac arrest, and when initiated, it was common not to achieve the target temperature of 32 to 34 degrees Celsius. They reviewed the records of 67,498 patients suffering a cardiac arrest and learned 1,367 patients—only 2%—received therapeutic hypothermia. Of those patients, 44.3% did not reach the target temperature within 24 hours, while 17.6% were cooled too much. Younger patients, those not in an intensive care unit, those at a teaching hospital, and the event happening on a weekday increased the likelihood of therapeutic hypothermia being started. The percentage of people receiving the therapy increased during the study period, from 0.7% in 2003 to 3.3% in 2009. The team, led by physicians from the Perelman School of Medicine of the University of Pennsylvania, Philadelphia, reported the findings in the journal Critical Care Medicine. More>>

Stanford to study cooling during transport
Hypoxic ischemic encephalopathy (HIE) remains a major cause of death and severe disability despite advances in neonatal and perinatal medicine. Stanford University in Palo Alto, Calif., is sponsoring an interventional, randomized clinical trial to test the efficacy of the cooling device in achieving the target temperatures in patients with moderate to severe HIE during transport when compared with current practices. The experimental cohort of about 50 infants will be placed on a cooling blanket connected to a cooling device, while the rest of the babies will receive passive or active cooling as per the participating centers’ practices. Nine facilities in California are participating. More>>

WEBINAR: Normothermia in Brain Injury
Featured Speaker: Farid G. Sadaka, MD
Mercy Hospital St. Louis/ St. Louis University St. Louis, MO

Recorded Session, Duration: 1 Hour

PODCAST
SCCM Pod-212 CCM: Therapeutic Hypothermia Following Sudden Cardiac Arrest
Jeffrey Guy, MD, MSc, MMHC, speaks with David R. Janz, MD, lead author on an article published in the December issue of Critical Care Medicine, “Hyperoxia is Associated with Increased Mortality in Patients Treated with Mild Therapeutic Hypothermia after Sudden Cardiac Arrest.” Investigators found that sudden cardiac arrest is associated with high hospital mortality and poor neurologic outcomes. Janz is a clinical fellow at Vanderbilt University School of Medicine in Nashville, Tennessee.

SCCM Pod-222: Therapeutic Hypothermia in Children
Michael Weinstein, MD, FACS, FCCP, speaks with Philip E. Empey, PharmD, PhD, BCPS, who discusses his Young Investigator Award winning abstract, “Phenytoin Concentrations Are Elevated in Children Receiving Therapeutic Hypothermia Following Traumatic Brain Injury,” which he presented on during the 42nd Critical Care Congress in San Juan, Puerto Rico. His research found that therapeutic hypothermia significantly reduced phenytoin elimination in children with severe traumatic brain injury leading to increased, supratherapeutic drug levels for an extended period of time after cooling. Dr. Empey is an Assistant Professor of Pharmacy and Therapeutics at the University of Pittsburgh in Pennsylvania. Released: 7/24/13

EDUCATION & TRAINING
NCS’ New ENLS Course Addresses the First Critical Hour of a Neurological Emergency
The Neurocritical Care Society (NCS) is a multidisciplinary, international organization whose mission is to improve outcomes for patients with life-threatening neurological illnesses.  Emergency Neurological Life Support (ENLS) has just been introduced and it is already drawing positive comments from career professionals. ENLS is designed to help standardize the approach to neurological emergencies during the first critical hour. Included in the 13 topic areas are Ischemic Stroke, Subarachnoid Hemorrhage and Traumatic Brain Injury – and others that are very relevant to improving outcomes. Besides physicians and nurses, ENLS is also recommended for physician assistants, pharmacists, residents and fellows – all members of the team confronted with a neurological emergency who want to enhance their knowledge and preparedness. The course provides 15 hours of Level 1 CME credit and two-year ENLS certification on completion.
More on ENLS     More on NCS

Clinical Management Strategies for Targeted Temperature Management (TTM)

The Medical Science Liaison (MSL) Group at Bard Medical is hosting a non-CME/CEU event on November 18th (Monday) from 6:00 - 8:00 PM at the Newport Beach Marriott Hotel & Spa. We have invited Teresa Wavra, Mary Kay Bader and Dr. Gene Sung to discuss "Clinical Management Strategies for Targeted Temperature Management(TTM)"
Upon completion of this course, the participant will be better able to:

• Describe how to implement a Targeted Tempearture Management (TTM) program.
• Manage common complications arising from TTM

Agenda:

• 5:00 - 6:00 PM - Registration and Networking Reception (food and beverages will be served)
• 6:00 - 6:50 PM - Targeted Temperature Management Program Implementation
• 7:00 - 8:00 PM - Mechanics and Practical Aspects of Targeted Temperature Management

There is no registration fee to attend this meeting, but registration is requested.

We look forward to seeing you.

Best regards,
The Medical Science Liaison (MSL) Group

When
Monday November 18, 2013 from 6:00 PM to 8:00 PM PST
Add to Calendar

Where
Newport Beach Marriott Hotel & Spa
900 Newport Beach Center Dr.
Newport Beach, CA 92660

Implementing Cardiac Resuscitation Systems of Care

The Medical Science Liaison (MSL) Group at Bard Medical is hosting a non-CME/CEU event on December 2nd (Monday) from 6:00 - 8:00 PM at the Indianapolis Marriott North Hotel (Keystone at the Crossing). We have invited Dr. Michael Mooney to discuss "Implementing Cardiac Resuscitation Systems of Care"

Upon completion of this course, the participant will be better able to:

• Describe how to implement a Cardiac Resuscitation Systems of Care.
• Manage common complications arising from TTM 

Agenda:

• 5:00 - 6:00 PM - Registration and Networking Reception (food and beverages will be served)
• 6:00 - 6:50 PM - Presentation
• 6:50 - 7:00 PM - Q& A

There is no registration fee to attend this meeting, but registration is requested. 

We look forward to seeing you.

Best regards,
The Medical Science Liaison (MSL) Group

When
Monday December 2, 2013 from 6:00 PM to 8:00 PM EST

Where
Indianapolis Marriott North Hotel 
Keystone at the Crossing
3645 River Crossing Pkwy
Indianapolis, IN 46240

Upcoming in October:

Satellite Breakfast Symposium

Talk: Mechanics and Practical Aspects

Objectives:

• Identify physiologic rationale for Targeted Temperature Management.
• Review clinical research addressing fever in brain injured patients.
• Develop clinical management strategies to minimize risk of potential complications of TTM.
• Review the practical aspects in establishing a Targeted Temperature Management protocol for the neurocritical care patient.

Speaker:
Neeraj Badjatia, MD, MS

Date/ Time: Oct 1, 2013,  Time: 07:00 – 08:00am

Place: Salon E, 5th Floor, Philadelphia Marriott Downtown, 1201 Market St., Philadelphia, PA 19107

No RSVP required
Breakfast will be at the Franklin Hall

The Greater New York Chapter (GNYC) of American Association of Neuroscience Nurses (AANN) is hosting the Time Is Brain™ Poster Cocktail Reception to raise awareness and educate members about Traumatic Brain Injury (TBI) including ongoing clinical trials. This networking event will be sponsored by a select group of industry leaders dedicated to research within the neuroscience community. Attendees will have ample opportunity to socialize with peers as well as pose questions and interact with presenters during the evening.

Date/ Time: Wednesday, October 30th, 6:00 pm to 8:00 pm

Place: The Kitano New York 66 Park Avenue at 38th Street, New York, NY 10016

To RSVP, please email Elaine Kopp, GNYC President at koppelaine@yahoo.com

Benjamin S. Abella, MD, MPhil
Vice Chair of Research, Department of Emergency Medicine, Clinical Research Director of the Center for Resuscitation Science

SPECIAL PRE-CONFERENCE WORKSHOP POST-ARREST THERAPEUTIC HYPOTHERMIA – A “HOW-TO” COURSE

Date:   24 October (the day before the Symposium)
Time:   14:00 - 20:00  
Location: Krakow, Poland, venue to be determined.

Led by a highly-experienced physician and nurse team at the University of Pennsylvania, this one-day workshop will update the participants with practical information about the implementation of post-arrest cooling therapy to improve outcomes.  Through small group discussions, problem-based learning and short lectures, participants will learn the newest information about practical questions such as:  inclusion/exclusion criteria for hypothermia?  What side effects should one look for?  How should side effects be managed? How can the brain be monitored during cooling therapy?  This workshop is ideal for physicians or nurses who are actively involved in the clinical care of patients following cardiac arrest. 

Space is limited to 30 registrants – please contact congress@erc.edu for further information.

Registration fee is 50 euro.