Strategies to implement a therapeutic hypothermia program
KeywordsCardiac Arrest Neurologic Outcome Therapeutic Hypothermia Catheterization Laboratory Successful Program
In this presentation we will review the process used for developing a therapeutic hypothermia program and our outcomes during the first year. Despite the fact that therapeutic hypothermia has been shown to improve survival and neurologic outcome after cardiac arrest , it is underused  and has been only slowly introduced in many institutions. One of the reasons that it is not more widely used may be the difficulty of implementation of a program.
A multidisciplinary team was assembled in 2007 to explore the opportunity for therapeutic hypothermia in patients after cardiac arrest. Pertinent literature was reviewed and a guideline and electronic orders were drafted. The team investigated all available options for cooling and chose a method that was non-invasive and did not require a large financial investment by the institution. Nurses were sent to an international program to learn about hypothermia and become advocates and educators. Education was done for caregivers in the prehospital setting, emergency department, cardiac catheterization laboratory, and adult ICUs. Advertising to community and other hospitals was done by newspaper, radio, and television. The team continued to meet regularly to assess and modify the program based on experience.
Prior to the start of this program, therapeutic hypothermia was essentially not utilized at the institution. Twenty-one patients were cooled after cardiac arrest and resuscitation at our institution in the first year (2008), with few missed opportunities. Fifteen (71%) survived, and 12 (57%) had good neurologic outcome. (Post-cardiac arrest survival rates without hypothermia in the literature range from less than 5% to 35% .) Challenges included altering historic practice patterns, integrating sectors of the healthcare delivery system that had historically drifted apart, and interacting with extra-institutional regulations governing prehospital care.
The therapeutic hypothermia program at our institution is successful in improving patient outcome after cardiac arrest. The elements that contributed to a successful program included: teamwork; multidisciplinary nature of the team; promoting awareness of the program; buy-in by nurses who championed the program in the ICU; positive patient outcomes; and low financial investment for the institution.