Implementation of Therapeutic Hypothermia Post-Cardiac Arrest in the Community Hospital Settin

Abstract

PURPOSE: Based on the landmark studies from Australia and Europe, survival rates for out of hospital cardiac arrest improved to 49 to 59 % with favorable neurologic outcomes when therapeutic hypothermia was introduced. Despite these favorable results, and recommendations to use Therapeutic Hypothermia in the 2005 American Heart Association ACLS Guidelines, adoption of Targeted Temperature Management for out of hospital cardiac arrest has been slow. There are multiple perceived barriers to implementation at Community Hospitals. The aim of this study was to introduce a hypothermia protocol for patients post VF/pulseless VT out of hospital cardiac arrest at a 405 bed community teaching hospital. METHODS: A multidisciplinary group lead by the Medical Director of Critical Care and the Clinical Nurse Specialist for Critical Care developed a standardized protocol for implementation of hypothermia in the post cardiac arrest patient with return of spontaneous circulation. Beginning in the pre-hospital setting, to the emergency department and into the Critical Care unit, external and intravascular cooling methods were begun and continued for 24 hours. An IRB approved registry was created, and data was collected on patient demographics, timing variables of arrest and cooling, limited lab values and outcomes evaluation based on the Cerebral Performance Category scoring tool. RESULTS: With the use of targeted temperature management for patients suffering out of hospital cardiac arrest from VF/pulseless VT a survival rate of 63% was realized. Of those that survived, 79% demonstrated a favorable outcome measured by a Cerebral Performance Category score of one or two. CONCLUSIONS: A hypothermia protocol can be safely and successfully implemented in a community hospital with outcomes comparable to studies from Australia and Europe. CLINICAL IMPLICATIONS: Targeted hypothermia protocols can be safely implemented in the community setting. Using established guidelines improved survival rates from cardiac arrest with favorable neurologic recovery leads to improved clinical outcomes.