Abstract 56: Variability in Patient Selection Criteria for Postarrest Protocols
The prevalence of therapeutic hypothermia (TH) for post-cardiac patients has yet to be established. Complicating this measure is the lack of standardized, universal recommendations on patient selection criteria for.TH. The objective of this study is to assess the amount of variability in patient selection criteria.
We conducted a systematic search of all publicly available TH protocols from published Internet sources. Protocols must be complete, associated with a hospital, and demonstrate clear patient selection criteria, to be included. The proportion of hospitals that considered each patient selection criteria was determined. Only descriptive statistics were provided. No statistical inferences were made.
A total of 64 TH protocols were assessed. Among the protocols, the patient selection criteria are viewed as Utstein based or non-Utstein based (Table 1). The Utstein variables considered were initial rhythm, witnessed, location, time to BLS, and age. Non-Utstein variables included were total ischemic time, time since ROSC, baseline body temperature, etiology of arrest, and hemodynamic parameters. The widest variability was noted in the category of “hemodynamic parameters.” Some hospitals (0.19) eliminate any patients with subjective evidence of “shock or instability.” Other hospitals vary in consideration of systolic blood pressure (0.44) or mean arterial pressure (0.27) to determine eligibility.
The results of this observational study indicate wide variability in the patient selection criteria for post-arrest protocols. The criteria provide stricter selection criteria than international guidelines recommend. Inconsistently applied criteria may exclude patients who would benefit from treatment. The impact of patient selection criteria could have an effect on measured national survival rates and outcomes.
- © 2012 by American Heart Association, Inc.