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  • Title: Adherence to therapeutic hypothermia guidelines for out-of-hospital cardiac arrest.
    Author: Boyce R, Bures K, Czamanski J, Mitchell M.
    Journal: Aust Crit Care; 2012 Aug; 25(3):170-7. PubMed ID: 22459557.
    Abstract:
    BACKGROUND: Out of hospital cardiac arrest is associated with a high rate of mortality, and poor neurological outcomes. Favourable neuro-protective effects are associated with induced hypothermia and international recommendations exist for therapeutic hypothermia. OBJECTIVE: This study reviews practice for therapeutic hypothermia for out of hospital cardiac arrest patients within one ICU. It aims to describe the level of adherence to the guideline, identify barriers to implementation and to improve adherence. SETTING: This project was conducted in an adult ICU which admits 2000 patients yearly. METHODS: A retrospective chart audit was used to document practice for a 12 month period. RESULTS: 33 patients were admitted to the ICU with a diagnosis of out of hospital cardiac arrest and met study inclusion criteria. From this sample of 33 patients, four patients (12%) were at the goal temperature of 32.5-33.5 °C, in the target time of 2h. Nearly half (n = 17) were not cooled at all. The length of time the patient was in the ICU prior to active cooling commencing varied from <1 h (n = 15, 45%) to >3 h (n = 5, 15%). Twenty-four percent (n = 9) were cooled for the recommended length of time. There were medical orders stating a target temperature in nearly half of the cases (n = 18), however, only 27% (n = 9) were consistent with the ICU guidelines. A number of strategies have been initiated. They aim to improve communication and ready access to the required materials. CONCLUSIONS: The audit indicated that less than a third of the patients experienced therapeutic induced hypothermia and only 12% were at goal temperature within the required 2 h. Strategies initiated to improve guideline implementation included; regular education sessions with ICU staff; placing a cooling blanket on the bed prior to admitting a patient post OOHCA; improving ready access to cooling agents and the addition of a care path for the induction and maintenance of therapeutic hypothermia to support and prompt clinicians when using the computerised patient record system.
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