Problem

Each year, many deaths occur in the US from out-of-hospital cardiac arrest. Of those that survive, a high percentage will later die or sustain severe neurological deficits; therefore, improvements in mortality and neurologic outcomes are needed. Therapeutic hypothermia (TH) is an evidence-based practice proven to have a positive neurological impact after sudden cardiac arrest. A hypothermia protocol should be utilized in the practice setting to improve patient outcomes.

Evidence

In 2002, two landmark studies showed that TH improved mortality and neurological outcomes in adult patients who had an out-of-hospital cardiac arrest from ventricular fibrillation or pulseless ventricular tachycardia. As a result of the evidence, the AHA and ILCOR recommended the use of TH in these patients (IIa recommendation) as well as other cardiac arrest rhythms and in-hospital patients (IIb recommendation).

Strategy

To adhere to the AHA & ILCOR recommended guidelines, in January 2009, Wilford Hall Medical Center (WHMC) formed a multidisciplinary team to review the literature and create an evidence-based protocol to be utilized in their ICU and ED.

Practice Change

Prior to implementation, staff was educated on the protocol and Alsius Thermagard by a sales representative and Nurse Educator via PowerPoint presentations, bulletin boards, and hands on training. Recruiting champions, providing evidence, continuous education and training helped influence acceptance of change.

Evaluation

The following data are collected on patients who receive the hypothermia protocol: date, time, age, sex, heart rhythm, time before ROSC, number of hours on therapy, and patient outcome. The data is reported to the South Texas Regional Advisory Council.

Results

WHMC was first in Department of Defense and first in San Antonio, Texas to implement therapeutic hypothermia! Since January 2009, nine patients received TH with two patients discharged home and one discharged to LTAC.

Recommendations

Therapeutic hypothermia is a necessary post-resuscitative treatment that should be a standard treatment strategy to preserve neurological status.

Lessons Learned

ED and ICU need to have better collaboration.

Bibliography

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• Bernard, S., Gray, T., Buist, M., Jones, B., Silvester, W., Gutteridge, G., et al. (2002). Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. The New England Journal of Medicine, 346(8), 557–563.
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• Hypothermia After Cardiac Arrest Study Group. (2002). Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. The New England Journal of Medicine, 346(8), 549–555.
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• Safar, P., & Kochanek, P. (2002). Therapeutic hypothermia after cardiac arrest. The New England Journal of Medicine, 346(8), 612–613.