Techniques to Prevent being in the Vegetative State after Cardiac Arrest
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The vegetative state is when you are lying still, and although you might be able to open your eyes, you will be unable to perceive anything, laugh, or cry. You will be unable to comprehend what you are doing. It is a condition in which the brain has lost its ability to perceive, understand and respond to stimuli and the environment. It occurs after a cardiac arrest because after the heart stops, there will be a shortage of blood and oxygen supply to the brain, which causes deaths to the cell brains. The patient’s cerebrum will no longer be able to function. Eventually, the person will enter into a state of disability and be unable to assist himself or herself before ultimately dying. However, we can prevent the vegetative state by using therapeutic hypothermia.
What is therapeutic hypothermia?
This is a technique that brain cells are treated to prevent or minimize brain damage after cardiac arrest. It works by reducing the body’s temperature below its normal level. Called “therapeutic hypothermia”, doctors reduce the body’s core temperature to about 33 degrees Celsius by as soon as possible or immediately after the heart starts beating again and then maintain temperature levels to remain steady for 24 hours.
Who should receive therapeutic hypothermia?
1. Patients who suffered from acute cardiac arrest who received CPR until the heart resumed normal function.
2. Patients suffering from cardiac arrest due to heart disease.
3. Patients who are in a coma who cannot follow any instruction but who could normally assist themselves before cardiac arrest.
4. Patients who do not suffer from various problems like bleeding disorders, blood infection, and abdominal injuries such as injuries to the liver or spleen, etc.
What is the treatment process of therapeutic hypothermia?
Temperature reduction stage: The doctor will reduce the body’s core temperature to about 33 degrees Celsius immediately after the heart returns to normal function. Temperature reduction might involve use of cooling pads or ice packs placed at the groins, neck, and armpits, and a cooling blanket will be used, along with an intravenous cooling substance, or endovascular cooling, which involves inserting a cooling catheter into the blood vessels to lower temperature with precision.
Temperature maintenance stage: After the temperature is lowered, it has to be maintained constant for 24 hours. Potential side effects include hypotension, slowed heart rate/arrhythmia, electrolyte imbalance, hardening of damaged blood vessels, chills, risk of infection, hyperglycemia and reduced liver function, etc.
Warm-up stage: After maintaining the body’s temperature for about 24 hours, the doctors will gradually increase the body’s temperature by using an electric blanket, an intravenous warming fluid or warm air. Doctors will continue to monitor the body’s changes across all systems such as by testing the effectiveness of the kidneys, brain, heart, blood coagulation and electrolyte balance.
Therapeutic hypothermia involves about 3 stages and about 3 days. During this time, doctors will try to find the cause of cardiac arrest and provide treatment simultaneously. If the cause is due to coronary artery stenosis, treatment might involve dilating the coronary arteries, for example.
Although therapeutic hypothermia has been used abroad for over 10 years, in Thailand, this method has only been used for about 4-5 years, and doctors who are skilled in therapeutic hypothermia in Thailand are few. However, Dr. Sombat Muengtaweepongsa, a brain crisis medical specialist at Phyathai 2 Hospital International, is one of those few doctors who can use this technique to treat patients at Phyathai 2 Hospital.
You may find our specialist here at Neurological Center, Phyathai 2 Hospital
Phyathai 2 Hospital
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Tel: +66-2617-2444 ext. 2020 or 2047 E mail: onestop@phyathai.com
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