2.50
Hdl Handle:
http://hdl.handle.net/10755/306554
Category:
Abstract
Type:
Poster
Title:
Welcome to the Ice Age: Systematic Approach to Cardiac Arrest
Author(s):
Williams, Valerie; Gordon, Nancy
Lead Author STTI Affiliation:
Non-member
Author Details:
Valerie Williams, BSN, RN, vmwilliams@geisinger.edu; Nancy Gordon; BSN, RN
Abstract:

Evidence-based Abstract

Purpose: To implement and evaluate an organized system of care for Out of Hospital Cardiac Arrest (OHCA) that utilizes specific protocols in the Emergency Department.

Design: In 2009 a process was implemented for systematic treatment of OHCA with return of spontaneous circulation (ROSC) for patients that remain in coma utilizing an integrated system of care that includes therapeutic hypothermia within the Emergency Department (ED) and prior to arrival. Utilizing the 2005 AHA guidelines and recommendations for mild therapeutic hypothermia, the process initiates a series of protocols that decrease body temperature of the comatose cardiac patient to 32-34 degrees centigrade for 12- 24 hours post arrest from time of ROSC. Patients are transferred to the ED from the field via Emergency Medical Services (EMS) or as ED transfers. This system approach aids in continuity of care and the availability of resources for this population of patients.

Setting: This quality improvement project takes place in a level 1 trauma center, tertiary care, teaching facility with 404 beds in rural central Pennsylvania. Emergency Department visits at this institution for fiscal year 2012 were 49,917.

Participants/Subjects: All adult patients greater than 18 years of age who present to the Emergency Department after OHCA and ROSC with coma beginning in 2009 to present. Patients are referred via EMS or ED to ED transfer. The program utilizes standardized guidelines with initiation of cooling at the first possible moment after ROSC. Referrals are made through the institution’s ED one call process or medical command.

Methods: This is an ongoing quality improvement process. At time of referral an “ARCTIC (Advanced Resuscitation Cooling Therapy in Cardiac Arrest) ALERT” is initiated within the institution and a series of set responses take place. All patients treated with “ARCTIC ALERT” protocol are reviewed by concurrent chart review with three month follow up of survivors. The protocol includes coordination with EMS or referring center to identify patients that meet inclusion criteria and initiation of cooling process as soon as possible post arrest. When the alert is activated a group of team members are paged with the following team members notified: charge nurse, nurse assigned, nursing supervisor, patient placement, pharmacy, ED physician staff and critical care medicine. An order set is utilized for protocol treatment which includes orders for hypothermia, bedside shivering scale, sedation, PCI, continuous EEG monitoring and early intervention by rehabilitation services.

Results/Outcomes: The institution has been able to show an overall 42% survival rate with good neurologic outcomes for patients with presumed cardiac etiology. An increase in survival was also noted after implementation of an immersion cooling device in the second half of 2011.

Implications: This rural institution has shown that an organized system of care has a positive effect on survival and outcome of patients with OHCA. Education of EMS and referring hospitals aids in patients receiving timely and appropriate resources and helps to improve delivery of early goal directed therapy in a consistent manner.

Keywords:
Cardiac Arrest
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Leadership Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Ft. Lauderdale, Florida, USA
Description:
2013 ENA Leadership Conference Theme: Shape the Future. Held at the Greater Fort Lauderdale Broward County Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleWelcome to the Ice Age: Systematic Approach to Cardiac Arresten_GB
dc.contributor.authorWilliams, Valerieen_GB
dc.contributor.authorGordon, Nancyen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsValerie Williams, BSN, RN, vmwilliams@geisinger.edu; Nancy Gordon; BSN, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306554-
dc.description.abstract<p>Evidence-based Abstract</p><p>Purpose: To implement and evaluate an organized system of care for Out of Hospital Cardiac Arrest (OHCA) that utilizes specific protocols in the Emergency Department.</p><p>Design: In 2009 a process was implemented for systematic treatment of OHCA with return of spontaneous circulation (ROSC) for patients that remain in coma utilizing an integrated system of care that includes therapeutic hypothermia within the Emergency Department (ED) and prior to arrival. Utilizing the 2005 AHA guidelines and recommendations for mild therapeutic hypothermia, the process initiates a series of protocols that decrease body temperature of the comatose cardiac patient to 32-34 degrees centigrade for 12- 24 hours post arrest from time of ROSC. Patients are transferred to the ED from the field via Emergency Medical Services (EMS) or as ED transfers. This system approach aids in continuity of care and the availability of resources for this population of patients.</p><p>Setting: This quality improvement project takes place in a level 1 trauma center, tertiary care, teaching facility with 404 beds in rural central Pennsylvania. Emergency Department visits at this institution for fiscal year 2012 were 49,917.</p><p> Participants/Subjects: All adult patients greater than 18 years of age who present to the Emergency Department after OHCA and ROSC with coma beginning in 2009 to present. Patients are referred via EMS or ED to ED transfer. The program utilizes standardized guidelines with initiation of cooling at the first possible moment after ROSC. Referrals are made through the institution’s ED one call process or medical command.</p><p>Methods: This is an ongoing quality improvement process. At time of referral an “ARCTIC (Advanced Resuscitation Cooling Therapy in Cardiac Arrest) ALERT” is initiated within the institution and a series of set responses take place. All patients treated with “ARCTIC ALERT” protocol are reviewed by concurrent chart review with three month follow up of survivors. The protocol includes coordination with EMS or referring center to identify patients that meet inclusion criteria and initiation of cooling process as soon as possible post arrest. When the alert is activated a group of team members are paged with the following team members notified: charge nurse, nurse assigned, nursing supervisor, patient placement, pharmacy, ED physician staff and critical care medicine. An order set is utilized for protocol treatment which includes orders for hypothermia, bedside shivering scale, sedation, PCI, continuous EEG monitoring and early intervention by rehabilitation services.</p><p>Results/Outcomes: The institution has been able to show an overall 42% survival rate with good neurologic outcomes for patients with presumed cardiac etiology. An increase in survival was also noted after implementation of an immersion cooling device in the second half of 2011.</p><p>Implications: This rural institution has shown that an organized system of care has a positive effect on survival and outcome of patients with OHCA. Education of EMS and referring hospitals aids in patients receiving timely and appropriate resources and helps to improve delivery of early goal directed therapy in a consistent manner.</p>en_GB
dc.subjectCardiac Arresten_GB
dc.date.available2013-12-09T16:59:41Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T16:59:41Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Leadership Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationFt. Lauderdale, Florida, USAen_GB
dc.description2013 ENA Leadership Conference Theme: Shape the Future. Held at the Greater Fort Lauderdale Broward County Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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