Out of Hospital Cardiac Arrest - Are we cooling enough?

Abstract

Introduction: Out of Hospital Cardiac Arrest (OOHCA) is associated with high mortality and morbidity (65—95%) and early active hypothermia protects the brain from further ischemic injury. Guidelines for early hypothermia are available, however, adherence and related issues are not known. Aim: This project aimed to identify issues with the implementation of OOHCA clinical Guidelines. Methods: A retrospective chart audit was conducted for a 12-month period on all patients presenting at the Emergency Department following OOHCA. Ethical approval was received. Results: 42 patients met the inclusion criteria. Of these 33 were admitted to ICU. At ‘target time’ (2 h), 4 patients were ‘at goal’. Forty-five percent of patients had cooling initiated within 1 h of admission; however, 51% were not cooled at all. The most frequent cooling method was a cooling blanket, followed by cooling hat or vest. Fifty-five percent had a target temperature documented but only 27% of these were in line with the Guidelines. Discussion: The Guidelines were not well adhered to and the issues were interdisciplinary. At times, orders were inconsistent with the Guidelines and cooling resources, (such as fluids) were underutilised. Improvements to adherence should be directed to interdisciplinary education thereby increasing awareness of this important intervention. Adequate resources are essential and need to be readily available. Conclusion: This audit highlighted a lack of adherence to Gold Standard patient hypothermia Guidelines with only 12% at the 2 h target. The identified issues were interdisciplinary and centre on awareness and accurate, timely implementation.