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Clinical Ladder III Literature Review

Literature Review 

The literature search I performed was in the database CINAHL, Medline, and Healthsource which are easily available on the university’s health science library website. I searched for the terms: “hypothermia”, “nursing care”, and “cardiac arrest”. The initial search resulted in over 500 articles, so I revised the search to include only articles on CINAHL that were published in the past five years. Since it was 2019 when I did my literature review, I limited my search to articles published between 2014 and 2019. Because I wanted to direct my attention specifically toward the nursing care of this population, I found that this search actually resulted in very few relevant high-quality articles so I expanded my search to include 2013. This resulted in 26 articles. I reviewed the results and focused my attention on high-quality articles such as systemic reviews or meta-analyses, research consisting of controlled trials without evidence of bias, and peer-reviewed articles. I have included a print out of my final search results at the end of this document and I have highlighted the articles I chose to utilize. 

The research on targeted temperature management and therapeutic hypothermia reveals that adults who receive this treatment suffer less morbidity and mortality (Madden, L., Hill, M., May, T., Human, T., McKenna Guanci, M., Jacobi, J… Badjatia, N.2017). Induced hypothermia has proven neuroprotective effects in patients who remain comatose after the return of spontaneous circulation following the onset of a condition that impairs circulation to the brain, such as a stroke or cardiac arrest. Hypothermia offers neuroprotection by decreasing oxygen demands, slowing metabolic processes, and negating the inconsequential undesirable effect of the body’s natural systemic inflammatory response (Williams, D., Calder, S., Cocchi, M. N., & Donnino, M. W.2013)To achieve maximum benefit treatment should be initiated and target temperature achieved as quickly as possible, target temperature maintained for at least 12 to 24 hours, and rewarming should occur slowly (Wyse McNett, 2016)For these reasons, endovascular cooling methods are preferred over surface cooling techniques.  

I learned that nursing care of a patient receiving induced hypothermia treatment focuses on maximizing the benefits of therapy while minimizing untoward physiological effects often associated with this treatment (Thomas, 2015).  According to Beseda, R., Smith, S., and Veenstra, A., meticulous nursing care is crucial in preventing complications such as healthcare-acquired infections, coagulopathies, shivering, alterations in skin integrity, and venous thromboembolism.  Continuous temperature monitoring and frequent assessments for complications are important. Cardiac dysrhythmias and hemodynamic changes can occur. Assessing for and minimizing shivering to prevent re-warming is an essential nursing function (Beseda, R., Smith, S., Veenstra, A., 2014). Finally, I learned that it is important to collaborate with providers regarding laboratory results, medications, fluid balance, as well as the treatment and prevention of complications. It is recommended that treatment protocols and clinical practice guidelines such as those created by The Ohio State University be developed using a multidisciplinary team approach (Mathiesen, C., McPherson, D., Ordway, C., Smith, M., 2015).