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Transcript presentation describing the project.
Raj Nichani
Blackpool Victoria Hospital
Strengthen collaboration across the region
Spread
good practice
Develop
exists.
on the tremendous potential that
Bernard SA, Gray TW, Buist MD, et al.
Treatment of comatose survivors of out-ofhospital cardiac arrest with induced
hypothermia. N Engl J Med. 2002;346:557–563.
The Hypothermia after Cardiac Arrest Study
Group. Mild therapeutic hypothermia to
improve the neurologic outcome after cardiac
arrest. N Engl J Med. 2002;346:549–556.
How
good are we with putting this evidence
into clinical practice.
Do
we achieve similar results outside the
settings of RCT’s.
Audit
Good
of our practice in Blackpool
success with the use of therapeutic
hypothermia
Outcomes
12
10
died during
cooling
inadequately
cooled
not cooled
8
6
4
2
VF
ie
d
D
VF
su
rv
iv
ed
0
cooled
All
survivors were discharged with good
neurological recovery
What
was everyone else doing across the
region/nationally with cooling?
Were
basic minimum standards being
achieved?
Was
any particular method better/more
eficient?
Were
other hospitals having similar
outcomes?
Are
patients being subjected to unacceptable
variations in practice?
Source
Do
of variation
these variations influence outcome?
Clear
and defined
Unequivocal
Key
individuals met and agreed on basic
standards.
All
4 hospitals represented
Proforma
and Database created
If a patient meets the criteria for cooling following
cardiac arrest then this should be initiated as soon as
possible and definitely within 6 hours of cardiac arrest.
Aim for a target core temperature of 32-34˚C
Core temperatures should be monitored continuously
during cooling and re-warming
The duration of cooling should be for 24 hours from
commencement of induced hypothermia and not when
target temperature is reached.
Re-warming should be at a rate of 0.3-0.5 ˚C per-hour
to 36.5˚C.
Central
database
Hopefully
Data
move to a Web based system
anonymised prior to submission ,
processed and fed back
Time
to initiation of cooling
10
9
8
7
6
5
4
3
2
1
0
hours
hospital Hospital Hospital Hospital
A
B
C
D
Target
temp reached
8
7
6
5
YES
NO
4
3
2
1
0
hosp A
hosp B
hosp C
hosp D
8
7
6
5
4
hours
3
2
1
0
hospital Hospital Hospital Hospital
A
B
C
D
Feedback
to hospital D
10
9
8
7
6
5
4
3
2
1
0
all hosptals
hospital D
JANMARCH
APRJUN
JULSEPT
OCTDEC
Clinically
relevant
Collaborative
numbers
Trainee
Audit – Larger patient
involvement
Potential
to spread to other regions
Generating
a large valuable local
database of patients.
Tremendous
source of useful data on regional
practices, patient outcome – Inform decision
making.
Are
we cooling non VF arrests / in hospital
arrests
What
is the outcome in a wider spectrum of
post VF/VT patients?
Benefits
vs Costs
Incentive
for units to drive up their
performance.
Funding
Links
of resources
with other networks -
The European Resuscitation Council Hypothermia
After Cardiac Arrest Registry Study Group
Dr
Tom Owen
Dr Rachel Markham
Dr Dominic Sebastian
Dr Alison Quinn
Dr Tina Duff
Dr Neil Moreland
Dr Richard Morgan
Dr Tom Hurst
Dr Brendan McGrath