Abstract 89: Penn State Hershey: 4-Year Experience in Mild Therapeutic Hypothermia Program---Lessons Learned

Abstract

Introduction: Mild Therapeutic Hypothermia (MTH) improves neurological outcomes in patients (pts) following sudden cardiac arrest with return of spontaneous circulation (SCA-ROSC). The Penn State Hershey Medical Center assembled a multispecialty team and formalized a MTH program in October 2007. Indications were expanded to include pts presenting with cerebrovascular trauma (CVT) and stroke in addition to SCA-ROSC. Methods: A multidisciplinary team of nurses and physicians (Emergency Medicine, Interventional Cardiology and Neurology) along with EMS (Life Lion) reviewed the scientific literature and created educational programs that were provided to the critical care units in the hospital. An electronic order set was created to standardize protocol. Life Lion provided education to Emergency Medicine programs at regional hospitals. Results: From October 1, 2007-March 29, 2011, 149 pts were enrolled in the MTH program (97 men, mean age 61.4 yr; 52 women, mean age 58.0 yr). 100 pts were enrolled for SCA; 1 pt enrolled following ICD failure; 5 pts enrolled post-CABG (cooling with ECMO); and 43 pts were enrolled following CVT/stroke. SCA-ROSC ranged from 5-45 min. Cardiac rhythm at the time of first medical contact (FMC) was as follows: VFib/VT:58 pts; asystole/PEA:42 pts; NSR:49 pts. Time to cooling (target 33°C) ranged from 2.5 - 10 hours with 3 pts receiving pre-hospital cooling. 64 pts (43%) survived to hospital discharge. 85 pts died (57%). Pittsburgh cerebral-performance category (CPC) level I-II was observed in 54.7% (n=35); CPC Level III-V was observed in 35.9% (n=23). 21 pts were discharged to a rehab facility. Of pts with FMC rhythm VFib/VT (n=56) there were 26 deaths (survival rate 53.6%). Of pts with FMC rhythm Asystole/PEA (n=39) there were 31 deaths (survival rate 20.5%). Conclusion: The MTH program was successfully implemented at our institution in pts presenting with SCA-ROSC and CVT/stroke. Pts with FMC cardiac rhythm of VFib/VT demonstrated better survival and neurological outcomes with MTH as compared to pts with FMC cardiac rhythm of asystole/PEA. Elements that have contributed to the success of our program include: a multidisciplinary approach; nursing leadership with an educational focus; and standardization of medical order sets.