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

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 (CHCA) 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 CHCA 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 CHCA 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. (C) 2008 Elsevier Ireland Ltd. All. rights reserved.