title: Use of a standardized order set for achieving target temperature in the implementation of therapeutic hypothermia after cardiac arrest: a feasibility study.
abstract: OBJECTIVE
  Induced hypothermia (HT) after cardiac arrest improved outcomes in randomized trials. Current post-cardiac arrest treatment guidelines advocate HT; however, utilization in practice remains low. One reported barrier to adoption is clinician concern over potential technical difficulty of HT. We hypothesized that using a standardized order set, clinicians could achieve HT target temperature in routine practice with equal or better efficiency than that observed in randomized trials.
  
  
  METHODS
  After a multidisciplinary HT education program, we implemented a standardized order set for HT induction and maintenance including sedation and paralysis, intravenous cold saline infusion, and an external cooling apparatus, with a target temperature range of 33-34 degrees C. We performed a retrospective analysis of a prospectively compiled and maintained registry of cardiac arrest patients with HT attempted (intent-to-treat) over the first year of implementation. The primary outcome measures were defined a priori by extrapolating treatment arm data from the largest and most efficacious randomized trial: 1) successful achievement of target temperature for >or=85% of patients in the cohort and 2) median time from return of spontaneous circulation (ROSC) to achieving target temperature <8 hours.
  
  
  RESULTS
  Clinicians attempted HT on 23 post-cardiac arrest patients (arrest location: 78% out-of-hospital, 22% in-hospital; initial rhythm: 26% ventricular fibrillation/tachycardia, 70% pulseless electrical activity or asystole) and achieved the target temperature in 22/23 (96%) cases. Median time from ROSC to target temperature was 4.4 (interquartile range 2.8-7.2) hours. Complication rates were low.
  
  
  CONCLUSIONS
  Using a standardized order set, clinicians can achieve HT target temperature in routine practice.
authors.affiliation: Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School at Camden, NJ, USA. kilgannon-hope@cooperhealth.edu
authors.forename: J Hope
authors.initials: JH
authors.lastname: Kilgannon
authors.forename: Brian W
authors.initials: BW
authors.lastname: Roberts
authors.forename: Mary
authors.initials: M
authors.lastname: Stauss
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Cimino
authors.forename: Lynn
authors.initials: L
authors.lastname: Ferchau
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chansky
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Parrillo
authors.forename: Stephen
authors.initials: S
authors.lastname: Trzeciak
mesh_terms: D000046:Academic Medical Centers; D001831:Body Temperature; D003422:Critical Care / Q000379:methods; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome