** The New Code Cool is being launched across our system.
** Focus on: Cooling times, resuscitation, hemodynamic management, ventilator management.
** Literature supports cooling to either 33C or 36C; we will continue to cool to 33C pending additional ongoing studies.
1. Use new “Code Cool – Induction” order set.
2. Activate Code Cool via PCL line (essential for nursing resources, ICU bed allocation, and patient tracking).
3. Consult cardiology and intensivisits on all Code Cools.
4. Cool to 33C unless intolerance to cooling (dysrhythmia), sepsis, or bleeding, then cool to 36C.
5. Induce cooling with ice packs, cold fluids 30cc/kg, and long-acting neuromuscular blockade (vec 10 mg IV)
6. Goal MAP > 70 mmHg at all times (> 80 mmHg if chronic HTN)
7. Treat blood pressure aggressively with norepinephrine (not dopamine)
8. Titrate FIO2 on ventilator down to 40% if possible while maintaining O2 sat > 95%.
9. Code Cool/STEMI: Activate Code STEMI also with age < 75, downtime < 20 min; others discuss immediately with intensivisits; don’t delay cooling.
10. Don’t delay initiation of cooling for CT imaging. Recall, few VF/VT arrests (< 5%) are due to PE.