Abstract 258: Emergency Department Involvement Reduces Subjectivity for Hypothermia
Background: Therapeutic hypothermia (TH) is an effective adjunctive therapy to standard post-resuscitation care for neurologically unresponsive survivors of cardiac arrest. TH has been demonstrated to improve survival and functional outcomes in this vulnerable patient population in a variety of academic and community hospital settings. We have previously reported that with an ICU-centered protocol in a community setting, patients who were subjectively deemed healthy prior to cardiac arrest received TH significantly more often than other patients who met TH protocol criteria.
Methods: A TH protocol was initiated in the intensive care unit (ICU) setting for comatose survivors of cardiac arrest in our 511-bed community teaching hospital for 12 months, January-December 2009. Based on initial outcomes data, the protocol was modified to include Emergency Department (ED) stakeholders beginning January 2010. With IRB approval, we conducted a retrospective chart review to evaluate TH application and outcomes for appropriate patients according to the Utstein style to identify whether ED involvement impacted patient selection for TH from January-December 2010.
Results: Five of 22 eligible patients received TH under the ICU-only protocol, and 5 of 20 eligible patients received TH under the ICU+ED protocol (p=NS). Comparing baseline assessments of “healthy” prior to cardiac arrest, significantly more healthy patients received TH under the ICU-only protocol (p=.02), whereas there was no significant difference in baseline assessments of healthy for patients receiving TH under the ICU+ED protocol (p=NS).
Conclusion: In a community teaching hospital with an ICU-centered TH protocol, adding ED stakeholder involvement to the TH protocol did not significantly influence the application of TH to eligible patients. However, this system-wide integration reduced the impact of a subjective assessment of a “healthy” pre-arrest state as an influencing factor for patients to receive TH. These findings warrant further investigation to identify means to better implement TH for appropriate patients, regardless of subjective pre-arrest health assessments.
- © 2011 by American Heart Association, Inc.