Initiate Therapeutic Hypothermia Nutrition and Medications Inclusion Criteria 1. Cardiac arrest with primary cardiac etiology 2. Initiation within 6-12 hours of ROSC 3. Unresponsive after ROSC (brainstem reflexes permissible) 4. Estimated time arrest to ROSC < 60 minutes Initiate Therapeutic Hypothermia STEMI/SHOCK: To cath lab (+/- IABP support) then to CVICU NON-STEMI: Admit directly to CVICU Utilize Arctic Sun with target temperature of 33°C until 24h post-arrest, rewarm at 0.25°C/hr and maintain temperature < 37.5°C for 72 hours post-arrest Sedation, Paralysis Preferentially propofol (Midazolam if hypotensive) Veuronium bolus then cistatracurium infusion Oxygenation/Ventilation/Acid-Base/Electrolytes ABG & electrolytes every 6 hours, continuous SpO2 Titrate to PaO2 80 -150/pCO2 32-48/pH 7.35-7.40 Permissive hypokalemia to >/= 2.8 mEq/L Target magnesium >/= 2 mEq/L Glucose monitor q1h with insulin infusion to maintain glucose 120-180 Family Care Palliative Care Consult on admission – regardless of the expected outcome Education regarding: indications of hypothermia, effects of hypothermia, length of time, risks of rewarming process Nutrition and Medications No nutrition until rewarming All medications IV until normothermic (exceptions: Clopidogrel by nasogastric tube, aspirin/acetaminophen per rectal) Hemodynamic Monitoring Arterial line PA Catheter/central line Transthoracic Echo MAP target: 80-90 (utilize norepinephrine, IABP for shock; nicardipine for hypertension) Neurological Assessment Head/Neck CT if unwitnessed or traumatic fall Seizure monitoring with continuous EEG Neurology consult, IV keppra and IV lorazepam for seizure activity Exclusion criteria: 1. Awakens spontaneously 2. Pregnancy, known terminal illness, recent major head trauma or traumatic arrest, bleeding, drug intoxication 3. Initial temperature < 93.2°F (34°C) CODE ICE Protocol Post-Cardiac Arrest Therapeutic Hypothermia Targeted Temperature Management