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. 2008 Nov;79(2):198-204.
doi: 10.1016/j.resuscitation.2008.08.014.

Outcomes of a hospital-wide plan to improve care of comatose survivors of cardiac arrest

Jon C Rittenberger  1 , Francis X Guyette, Samuel A Tisherman, Michael A DeVita, Rene J Alvarez, Clifton W Callaway
Affiliations

Outcomes of a hospital-wide plan to improve care of comatose survivors of cardiac arrest

Jon C Rittenberger et al. Resuscitation. 2008 Nov.

Abstract

Background: Therapeutic hypothermia (TH) improves outcomes in comatose survivors of cardiac arrest. Few hospitals have protocol-driven plans that include TH. We implemented a series of process interventions designed to increase TH use and improve outcomes in patients successfully resuscitated from out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA).

Methods and results: Linked interventions including a TH order sheet, verbal and written feedback to individual providers, an educational program, TH "kit" and on-call consultants to assist with patient care and hypothermia induction were implemented between January 1, 2005 and December 31, 2007 in a large, university-affiliated, tertiary care center. We then completed a retrospective review of all patients treated for cardiac arrest during the study period. Descriptive statistics, chi-squared analyses, or Fisher's exact test were used as appropriate. A p value <0.05 was considered significant. 135 OHCA patients and 106 IHCA patients were eligible for post-arrest care. TH use increased each year in the OHCA group (from 6% to 65% to 76%; p<0.001) and IHCA group (from 0% to 36% to 53%; p=.02). A good outcome was achieved in 21% and 8% of comatose patients with OHCA and IHCA, respectively. Patients with OHCA and ventricular dysrhythmia were more likely to have a good outcome with TH treatment than without it (good outcome in 57% vs. 8%; p=.005).

Conclusion: Implementing a series of aggressive interventions increased appropriate TH use and was associated with improved outcomes in our facility.

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Figures

Figure 1
Figure 1
Flowchart of patients with cardiac arrests from 2005 to 2007. A. Out-of-hospital cardiac arrest (OHCA). B. In-hospital cardiac arrest (IHCA). CMO- comfort measures only; GCS- Glasgow Coma Score; TH- therapeutic hypothermia. A good neurologic outcome was defined as discharge to the patient’s home or to an acute rehabilitation center.
Figure 2
Figure 2
Outcomes of comatose survivors of cardiac arrest from 2005 to 2007, stratified by type of first rhythm and by category of cardiac arrest. OHCA indicates out-of-hospital cardiac arrest; IHCA, in-hospital cardiac arrest; VF, ventricular fibrillation; VT, ventricular tachycardia; rehab, acute rehabilitation center; and SNF, skilled nursing facility.
Figure 2
Figure 2
Outcomes of comatose survivors of cardiac arrest from 2005 to 2007, stratified by type of first rhythm and by category of cardiac arrest. OHCA indicates out-of-hospital cardiac arrest; IHCA, in-hospital cardiac arrest; VF, ventricular fibrillation; VT, ventricular tachycardia; rehab, acute rehabilitation center; and SNF, skilled nursing facility.
Figure 2
Figure 2
Outcomes of comatose survivors of cardiac arrest from 2005 to 2007, stratified by type of first rhythm and by category of cardiac arrest. OHCA indicates out-of-hospital cardiac arrest; IHCA, in-hospital cardiac arrest; VF, ventricular fibrillation; VT, ventricular tachycardia; rehab, acute rehabilitation center; and SNF, skilled nursing facility.
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