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

Authors

• J Hope Kilgannon
• Brian W Roberts
• Mary Stauss
• Mary Jo Cimino
• Lynn Ferchau
• Michael E Chansky
• R Phillip Dellinger
• Joseph E Parrillo
• Stephen Trzeciak

Publication/Presentation Date

6-1-2008

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 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.

Volume

15

Issue

6

First Page

499

Last Page

505

ISSN

1553-2712

Published In/Presented At

Kilgannon, J. H., Roberts, B. W., Stauss, M., Cimino, M. J., Ferchau, L., Chansky, M. E., Dellinger, R. P., Parrillo, J. E., & Trzeciak, S. (2008). Use of a standardized order set for achieving target temperature in the implementation of therapeutic hypothermia after cardiac arrest: a feasibility study. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 15(6), 499–505. https://doi.org/10.1111/j.1553-2712.2008.00102.x

Disciplines

Medicine and Health Sciences

PubMedID

18616434

Department(s)

Department of Medicine

Document Type

Article