Abstract 130: A Wide Variation Exists in the Utilization of “Bundles of Care” Between Institutional Therapeutic Hypothermia Protocols and Published Implementation Studies
Background: Therapeutic hypothermia (TH) improves outcomes in comatose post-cardiac arrest syndrome (PCAS) patients but produces its own well-described set of side effects, which interacts with post-arrest pathophysiology to produce clinical management challenges. The 2008 AHA Consensus Statement on PCAS suggests adoption of a comprehensive clinical pathway, or bundle of care, for management of PCAS patients.
Objective: To compare utilization of care bundles in adult institutional protocols (IP) versus implementation studies (IS).
Methods: Seven explicit components of a bundle of care were chosen a priori: hemodynamics, volume status, echocardiogram, early PCI, ventilator management, prophylaxis (VTE, stress ulcer, antibiotics), and glucose control. We performed a Medline search using the terms TH, implementation, cardiac arrest, and coma for the time period between 3/2002–3/2010. Database studies were excluded. Identified IS were examined for mention of bundle components. In addition, we examined IP posted @ the Penn Center for Resuscitation Science website (www.med.upenn.edu/resuscitation/hypothermia/). Consistent with previous recommendations, an IS or IP met minimum criteria for a care bundle if at least 4 components were described.
Results: A total of 46 IS and 37 IP were identified. Three database studies, one pediatric and one neonatal protocol, and three adult TH order sets were excluded leaving 43 IS and 32 adult IP for analysis. The median number of explicitly stated bundle elements was 2 (range 0–7) for IS vs 4 (range 0–7) for IP; 19 IS and 2 IP mentioned no bundle elements. Minimum criteria for a care bundle were met by 10/43 (23%) IS vs 16/32 (50%) IP. Individual elements were addressed to a variable degree in IS vs IP: hemodynamics, 19/43 (44%) vs 26/32 (81%); volume status, 11/43 (26%) vs 22/32 (69%); echocardiogram 7/43 (16%) vs 5/32 (16%); early PCI, 14/43 (33%) vs 9/32 (28%); ventilator management, 8/43 (19%) vs 14/32 (44%); prophylaxis, 3/43 (7%) vs 14/32 (44%); and glucose control, 13/43 (30%) vs 18/32 (56%).
Conclusions: Bundles of care are used more frequently in real world institutional protocols vs implementation studies. These results highlight the need for additional research to define the optimal care bundle for PCAS patients.
- © 2010 by American Heart Association, Inc.