Standard operating procedures in postresuscitation care: facilitated realisation therapeutic measures in daily practice

Introduction

Clinical and experimental investigations have demonstrated improved outcome following therapeutic mild hypothermia after successful resuscitation. In septic shock, implementation of 'standard operating procedures' improves outcome. To advance treatment and outcome in patients after successful prehospital resuscitation, we established in August 2005, at our medical ICU at the Heart Centre Freiburg, an evidence-based standard operating procedures in postresuscitation care. To evaluate enforcement and quality of postresuscitation care in daily practice we compared achievement and realisation of our standard operating procedure before and after introduction.

Methods

During 2001–2006 a total of 229 patients, after successful prehospital resuscitation, were assigned to our medical heart centre. One hundred and seventy-seven (77%) patients fulfilled the inclusion criteria and 89 (39%) of the patients were treated with mild hypothermia. In August 2005, we established at our medical ICU standard operating procedures in postresuscitation care. We compared retrospectively patients treated with mild hypothermia before (control group) and after August 2005 (SOP group) concerning inclusion and realisation of therapeutic hypothermia and achievement of the target temperature.

Results

There were no differences in age and number of patients with cooling indication. After the implementation of the standard operating procedure, significantly more patients were cooled (52/132, 39% versus 37/46, 80%; P < 0.05). In the SOP group, the target temperature could be reached significantly faster compared with patients treated without SOP after admission to the hospital (372 ± 187 min versus 1,117 ± 761 min, P < 0.05) and after admission to the ICU (264 ± 188 min versus 940 ± 607 min, P < 0.05).

Conclusion

Standard operating procedures in postresuscitation care could facilitate realisation of therapeutic measures in daily practice. Here we showed that the implementation of an evidence-based standard reduced the time to achieve the target temperature and decreased the number of patients treated with mild hypothermia after successful resuscitation. Although time course and duration to achieve the target temperature is known to play a crucial role in this therapeutic concept, this will be a step to improve outcome of these patients.