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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
Author(s) -
Hope Kilgan J.,
Roberts Brian W.,
Stauss Mary,
Jo Cimino Mary,
Ferchau Lynn,
Chansky Michael E.,
Phillip Dellinger R.,
Parrillo Joseph E.,
Trzeciak Stephen
Publication year - 2008
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2008.00102.x
Subject(s) - medicine , hypothermia , targeted temperature management , set (abstract data type) , intensive care medicine , anesthesia , cardiopulmonary resuscitation , resuscitation , return of spontaneous circulation , computer science , programming language
Abstract Objectives: 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°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 ≥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.