Hypothermia post OOH Arrest A proposed ANWICU initiative

1. Hypothermia post OOH ArrestA proposed ANWICU initiative Raj Nichani Blackpool Victoria Hospital

2. KNOWLEDGE • Strengthen collaboration across the region • Spread good practice • Develop on the tremendous potential that exists.

3. Chain of Survival

4. Therapeutic Hypothermia post VF Arrest – the evidence • Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–563. • The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–556.

5. How good are we with putting this evidence into clinical practice. • Do we achieve similar results outside the settings of RCT’s.

6. National variation in cooling practices

7. Why this project? • Audit of our practice in Blackpool • Good success with the use of therapeutic hypothermia

8. Outcomes

9. Outcomes • All survivors were discharged with good neurological recovery

10. Questions generated • What was everyone else doing across the region/nationally with cooling? • Were basic minimum standards being achieved? • Was any particular method better/more eficient? • Were other hospitals having similar outcomes?

11. Bottom line • Are patients being subjected to unacceptable variations in practice? • Source of variation • Do these variations influence outcome?

12. What standards • Clear and defined • Unequivocal

13. lancs + cumbria network project • Key individuals met and agreed on basic standards. • All 4 hospitals represented • Proforma and Database created

14. Ideal standards – ILCOR • If a patient meets the criteria for cooling following cardiac arrest then this should be initiated as soon as possible and definitely within 6 hours of cardiac arrest. • Aim for a target core temperature of 32-34˚C • Core temperatures should be monitored continuously during cooling and re-warming • The duration of cooling should be for 24 hours from commencement of induced hypothermia and not when target temperature is reached. • Re-warming should be at a rate of 0.3-0.5 ˚C per-hour to 36.5˚C.

15. Data collection • Central database • Hopefully move to a Web based system • Data anonymised prior to submission , processed and fed back

16. Time to initiation of cooling

17. Target temp reached

18. Median Time to target temperature

19. Raise the standard of practice – feedback to individual units • Feedback to hospital D

20. Potential Benefits • Clinically relevant • Collaborative Audit – Larger patient numbers • Trainee involvement • Potential to spread to other regions • Generating a large valuable local database of patients.

21. Generate valuable data • Tremendous source of useful data on regional practices, patient outcome – Inform decision making. • Are we cooling non VF arrests / in hospital arrests • What is the outcome in a wider spectrum of post VF/VT patients? • Benefits vs Costs

22. Incentive for units to drive up their performance. • Funding of resources • Links with other networks -

23. The European Resuscitation Council Hypothermia After Cardiac Arrest Registry Study Group

24. Contributors • Dr Tom Owen • Dr Rachel Markham • Dr Dominic Sebastian • Dr Alison Quinn • Dr Tina Duff • Dr Neil Moreland • Dr Richard Morgan • Dr Tom Hurst • Dr Brendan McGrath