Hospital-wide therapeutic hypothermia protocol significantly reduces the time to induce hypothermia but does not improve outcomes

Introduction

Therapeutic hypothermia (TH) is a reliable, evidence-based modality to improve neurological outcome following out-of-hospital cardiac arrest. Often TH is induced in the ICU and as a result the time from cardiac arrest (CA) to induction of TH (TH_st) and achieving target temperature (CA_ta) is delayed. Preliminary data have shown that delaying TH may worsen outcome [1]. We sought to investigate whether a hospital-wide approach to TH after CA would reduce delays and result in improved outcomes.

Methods

We conducted a retrospective analysis of all TH interventions from 2007 to 2008. Following this we implemented a hospital-wide approach to TH and re-evaluated in 2008 to 2009. The hospital-wide approach included an educational programme, TH guidelines in the resuscitation room in the ED, and a cooling pack stored in the ICU which could be taken immediately to the post-CA patient.

Results

CA-ROSC and CA-Hosp delays were similar between groups. The hospital-wide approach significantly reduced the time to initiate TH and time to achieve target temperature (see Table 1). The small sample size may have prohibited demonstration of outcome differences.

Table 1 Differences between groups pre and post the hospital-wide approach

Conclusions

A hospital-wide approach to TH following cardiac arrest significantly reduces delays to achieve the target temperature, although this did not improve outcomes at our institution. Initiation of prehospital TH may be an ideal solution to further reduce this delay, and ongoing trials may demonstrate improved outcomes.