Document Detail


Implementation of a standardized pathway for the treatment of cardiac arrest patients using therapeutic hypothermia: "CODE ICE".
MedLine Citation:
PMID:  22825528     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Out-of-hospital cardiac arrest is common and is associated with high mortality. The majority of in-hospital deaths from resuscitated victims of cardiac arrest are due to neurologic injury. Therapeutic hypothermia (TH) is now recommended for the management of comatose survivors of cardiac arrest. The rapid triage and standardized treatment of cardiac arrest patients can be challenging, and implementation of a TH program requires a multidisciplinary team approach. In 2010, we revised our institution's TH protocol, creating a "CODE ICE" pathway to improve the timely and coordinated care of cardiac arrest patients. As part of CODE ICE, we implemented comprehensive care pathways including measures such as a burst paging system and computerized physician support tools. "STEMI on ICE" integrates TH with our regional ST-elevation myocardial infarction network. Retrospective data were collected on 150 consecutive comatose cardiac arrest victims treated with TH (n = 82 pre-CODE ICE and n = 68 post-CODE ICE) from 2007 to 2011. After implementation of CODE ICE, the mean time to initiation of TH decreased from 306 ± 165 minutes to 196 ± 144 minutes (P < 0.001), and the time to target temperature decreased from 532 ± 214 minutes to 392 ± 215 minutes (P < 0.001). There was no significant change in survival or neurologic outcome at hospital discharge. Through the implementation of CODE ICE, we were able to reduce the time to initiation of TH and time to reach target temperature. Additional studies are needed to determine the effect of CODE ICE and similar pathways on clinical outcomes after cardiac arrest.
Authors:
Ryan D Hollenbeck; Quinn Wells; Jeremy Pollock; Michael B Kelley; Chad E Wagner; Michael E Cash; Carol Scott; Kathy Burns; Ian Jones; Joseph L Fredi; John A McPherson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical pathways in cardiology     Volume:  11     ISSN:  1535-2811     ISO Abbreviation:  Crit Pathw Cardiol     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-07-24     Completed Date:  2012-12-04     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  101165286     Medline TA:  Crit Pathw Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  91-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiopulmonary Resuscitation
Coma / etiology,  therapy*
Critical Pathways / standards*
Decision Support Systems, Clinical
Emergency Medical Services / methods*
Female
Heart Arrest / complications,  therapy*
Humans
Hypothermia, Induced / methods*
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / complications,  therapy
Retrospective Studies
Tertiary Care Centers
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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