Which alteration to the standard acls algorithm is appropriate for hypothermia?

Introduction

When managing a patient with hypothermia, it is essential to consider alterations to the standard Advanced Cardiac Life Support (ACLS) algorithm. Hypothermia significantly affects the body’s physiology and can complicate resuscitation efforts. This article will explore the appropriate alteration to the standard ACLS algorithm for hypothermia, providing insights into the management of these patients.

The Effects of Hypothermia on Resuscitation

Hypothermia, defined as a core body temperature below 35°C (95°F), has profound effects on the body’s physiology. It slows down metabolic processes, impairs cardiac function, and alters drug metabolism. These factors can make resuscitation challenging and necessitate modifications to the standard ACLS algorithm.

Temperature Assessment: Accurate temperature assessment is crucial in managing hypothermic patients. Hypothermia can lead to unreliable peripheral temperature measurements, as the body conserves heat by shunting blood away from the extremities. Therefore, core temperature measurement, such as rectal or bladder temperature, is recommended.

Cardiac Arrest Management: In hypothermic cardiac arrest, the standard ACLS algorithm may need to be altered. The initial steps of cardiopulmonary resuscitation (CPR) and defibrillation remain the same. However, the duration of CPR before considering termination should be extended in hypothermic patients, as they may have a higher likelihood of successful resuscitation even after prolonged periods of arrest.

Alteration to the Standard ACLS Algorithm for Hypothermia

Defibrillation Threshold: Hypothermia increases the defibrillation threshold, requiring higher energy levels for successful defibrillation. The standard ACLS algorithm recommends an initial biphasic energy level of 120-200 Joules for defibrillation. However, in hypothermic patients, higher energy levels, such as 200-360 Joules, may be necessary to achieve defibrillation success.

Drug Therapy: Hypothermia affects drug metabolism and distribution, necessitating alterations in drug therapy during resuscitation. The administration of vasopressors, such as epinephrine, should be delayed until the core temperature reaches 30°C (86°F) or higher. This delay is important to prevent peripheral vasoconstriction, which can exacerbate hypoperfusion in hypothermic patients.

Perfusion Assessment: In hypothermic patients, the accuracy of clinical signs, such as capillary refill and pulse quality, may be compromised. Therefore, additional methods of perfusion assessment, such as arterial blood gas analysis or central venous oxygen saturation monitoring, should be considered to guide resuscitation efforts.

Conclusion

When managing hypothermic patients, alterations to the standard ACLS algorithm are necessary to optimize resuscitation outcomes. These alterations include adjusting the defibrillation threshold, modifying drug therapy, and utilizing alternative methods for perfusion assessment. By recognizing the unique challenges posed by hypothermia, healthcare providers can improve the management and outcomes of these patients.

References

1. American Heart Association. (2015). Part 10: Special Circumstances of Resuscitation. In *2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care* (pp. S256-S268). Retrieved from heart.org
2. Soar, J., et al. (2015). European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult Advanced Life Support. *Resuscitation*, 95, 100-147. doi:10.1016/j.resuscitation.2015.07.016