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Use of a standardized order set for achieving target temperature in the implementation of therapeutic hypothermia after cardiac arrest: a feasibility study.

AbstractOBJECTIVES:
Induced hypothermia (HT) after cardiac arrest improved outcomes in randomized trials. Current post-cardiac arrest treatment guidelines advocate HT; however, utilization in practice remains low. One reported barrier to adoption is clinician concern over potential technical difficulty of HT. We hypothesized that using a standardized order set, clinicians could achieve HT target temperature in routine practice with equal or better efficiency than that observed in randomized trials.
METHODS:
After a multidisciplinary HT education program, we implemented a standardized order set for HT induction and maintenance including sedation and paralysis, intravenous cold saline infusion, and an external cooling apparatus, with a target temperature range of 33-34 degrees C. We performed a retrospective analysis of a prospectively compiled and maintained registry of cardiac arrest patients with HT attempted (intent-to-treat) over the first year of implementation. The primary outcome measures were defined a priori by extrapolating treatment arm data from the largest and most efficacious randomized trial: 1) successful achievement of target temperature for >or=85% of patients in the cohort and 2) median time from return of spontaneous circulation (ROSC) to achieving target temperature <8 hours.
RESULTS:
Clinicians attempted HT on 23 post-cardiac arrest patients (arrest location: 78% out-of-hospital, 22% in-hospital; initial rhythm: 26% ventricular fibrillation/tachycardia, 70% pulseless electrical activity or asystole) and achieved the target temperature in 22/23 (96%) cases. Median time from ROSC to target temperature was 4.4 (interquartile range 2.8-7.2) hours. Complication rates were low.
CONCLUSIONS:
Using a standardized order set, clinicians can achieve HT target temperature in routine practice.
AuthorsJ Hope Kilgannon, Brian W Roberts, Mary Stauss, Mary Jo Cimino, Lynn Ferchau, Michael E Chansky, R Phillip Dellinger, Joseph E Parrillo, Stephen Trzeciak
JournalAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine (Acad Emerg Med) Vol. 15 Issue 6 Pg. 499-505 (Jun 2008) ISSN: 1553-2712 [Electronic] United States
PMID18616434 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Topics
  • Academic Medical Centers
  • Body Temperature
  • Critical Care (methods)
  • Emergency Service, Hospital
  • Feasibility Studies
  • Female
  • Heart Arrest (mortality, therapy)
  • Humans
  • Hypothermia, Induced (standards)
  • Male
  • Middle Aged
  • Registries
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome

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