Outcomes of a hospital-wide plan to improve care of comatose survivors of cardiac arrest
Summary 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...
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| Veröffentlicht in: | Resuscitation 2008-11, Vol.79 (2), p.198-204 |
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| creator | Rittenberger, Jon C Guyette, Francis X Tisherman, Samuel A DeVita, Michael A Alvarez, Rene J Callaway, Clifton W |
| description | Summary 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 |
| doi_str_mv | 10.1016/j.resuscitation.2008.08.014 |
| format | Article |
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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.</description><identifier>ISSN: 0300-9572</identifier><identifier>EISSN: 1873-1570</identifier><identifier>DOI: 10.1016/j.resuscitation.2008.08.014</identifier><identifier>PMID: 18951113</identifier><identifier>CODEN: RSUSBS</identifier><language>eng</language><publisher>Shannon: Elsevier Ireland Ltd</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiopulmonary resuscitation (CPR) ; Clinical Protocols ; Cohort Studies ; Coma - therapy ; Emergency ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care ; Emergency Service, Hospital - organization & administration ; Female ; Heart arrest ; Heart Arrest - psychology ; Heart Arrest - therapy ; Humans ; Hypothermia ; Hypothermia, Induced ; Intensive care medicine ; Male ; Medical sciences ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Resuscitation ; Retrospective Studies ; Translational research</subject><ispartof>Resuscitation, 2008-11, Vol.79 (2), p.198-204</ispartof><rights>Elsevier Ireland Ltd</rights><rights>2008 Elsevier Ireland Ltd</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c574t-4113dbc6ec4e9546935b2a6d254c892dc6b3df29770e7244b2c6e2a73f71905c3</citedby><cites>FETCH-LOGICAL-c574t-4113dbc6ec4e9546935b2a6d254c892dc6b3df29770e7244b2c6e2a73f71905c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0300957208006564$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20873852$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18951113$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rittenberger, Jon C</creatorcontrib><creatorcontrib>Guyette, Francis X</creatorcontrib><creatorcontrib>Tisherman, Samuel A</creatorcontrib><creatorcontrib>DeVita, Michael A</creatorcontrib><creatorcontrib>Alvarez, Rene J</creatorcontrib><creatorcontrib>Callaway, Clifton W</creatorcontrib><title>Outcomes of a hospital-wide plan to improve care of comatose survivors of cardiac arrest</title><title>Resuscitation</title><addtitle>Resuscitation</addtitle><description>Summary 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.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiopulmonary resuscitation (CPR)</subject><subject>Clinical Protocols</subject><subject>Cohort Studies</subject><subject>Coma - therapy</subject><subject>Emergency</subject><subject>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</subject><subject>Emergency Service, Hospital - organization & administration</subject><subject>Female</subject><subject>Heart arrest</subject><subject>Heart Arrest - psychology</subject><subject>Heart Arrest - therapy</subject><subject>Humans</subject><subject>Hypothermia</subject><subject>Hypothermia, Induced</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Resuscitation</subject><subject>Retrospective Studies</subject><subject>Translational research</subject><issn>0300-9572</issn><issn>1873-1570</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNktFr1TAUxoMo7jr3L0hB9K3XkzRpGoSBjLkJgz2osLeQpqcu17apSdux_36p9zKdT0IgD-d3vvMl3yHkLYUtBVp-2G0DxjlaN5nJ-WHLAKrteih_Rja0kkVOhYTnZAMFQK6EZEfkVYw7ACiEki_JEa2UoJQWG3JzPU_W9xgz32Ymu_VxTLpdfucazMbODNnkM9ePwS-YWRNw5VKDmXzELM5hcYsPv7tTtXHGZiYkf9Nr8qI1XcSTw31Mvn8-_3Z2mV9dX3w5-3SVWyH5lPPkoqltiZajErxUhaiZKRsmuK0Ua2xZF03LlJSAknFes8QyI4tWUgXCFsfkdK87znWPjcVhCqbTY3C9CffaG6efVgZ3q3_4RTOhoOSQBN4fBIL_NSfnunfRYpfejn6OulQSVAUr-HEP2uBjDNg-DqGg12T0Tj9JRq_J6PVQnrrf_O3zT-8higS8OwAmWtO1wQzWxUeOQQq2Eixx53sO068uDoNOA3Gw2LiAdtKNd_9p6PQfHdu5waXRP_Ee487PYUjBaaoj06C_rsu07hKkvyhFyYsHZ7nLXg</recordid><startdate>20081101</startdate><enddate>20081101</enddate><creator>Rittenberger, Jon C</creator><creator>Guyette, Francis X</creator><creator>Tisherman, Samuel A</creator><creator>DeVita, Michael A</creator><creator>Alvarez, Rene J</creator><creator>Callaway, Clifton W</creator><general>Elsevier Ireland Ltd</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20081101</creationdate><title>Outcomes of a hospital-wide plan to improve care of comatose survivors of cardiac arrest</title><author>Rittenberger, Jon C ; Guyette, Francis X ; Tisherman, Samuel A ; DeVita, Michael A ; Alvarez, Rene J ; Callaway, Clifton W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c574t-4113dbc6ec4e9546935b2a6d254c892dc6b3df29770e7244b2c6e2a73f71905c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiopulmonary resuscitation (CPR)</topic><topic>Clinical Protocols</topic><topic>Cohort Studies</topic><topic>Coma - therapy</topic><topic>Emergency</topic><topic>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</topic><topic>Emergency Service, Hospital - organization & administration</topic><topic>Female</topic><topic>Heart arrest</topic><topic>Heart Arrest - psychology</topic><topic>Heart Arrest - therapy</topic><topic>Humans</topic><topic>Hypothermia</topic><topic>Hypothermia, Induced</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>Resuscitation</topic><topic>Retrospective Studies</topic><topic>Translational research</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rittenberger, Jon C</creatorcontrib><creatorcontrib>Guyette, Francis X</creatorcontrib><creatorcontrib>Tisherman, Samuel A</creatorcontrib><creatorcontrib>DeVita, Michael A</creatorcontrib><creatorcontrib>Alvarez, Rene J</creatorcontrib><creatorcontrib>Callaway, Clifton W</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Resuscitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rittenberger, Jon C</au><au>Guyette, Francis X</au><au>Tisherman, Samuel A</au><au>DeVita, Michael A</au><au>Alvarez, Rene J</au><au>Callaway, Clifton W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of a hospital-wide plan to improve care of comatose survivors of cardiac arrest</atitle><jtitle>Resuscitation</jtitle><addtitle>Resuscitation</addtitle><date>2008-11-01</date><risdate>2008</risdate><volume>79</volume><issue>2</issue><spage>198</spage><epage>204</epage><pages>198-204</pages><issn>0300-9572</issn><eissn>1873-1570</eissn><coden>RSUSBS</coden><abstract>Summary 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.</abstract><cop>Shannon</cop><pub>Elsevier Ireland Ltd</pub><pmid>18951113</pmid><doi>10.1016/j.resuscitation.2008.08.014</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Resuscitation, 2008-11, Vol.79 (2), p.198-204 |
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| subjects | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cardiopulmonary resuscitation (CPR) Clinical Protocols Cohort Studies Coma - therapy Emergency Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Emergency Service, Hospital - organization & administration Female Heart arrest Heart Arrest - psychology Heart Arrest - therapy Humans Hypothermia Hypothermia, Induced Intensive care medicine Male Medical sciences Middle Aged Outcome and Process Assessment (Health Care) Resuscitation Retrospective Studies Translational research |
| title | Outcomes of a hospital-wide plan to improve care of comatose survivors of cardiac arrest |
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