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Implementation of a standardized pathway for the treatment of cardiac arrest patients using therapeutic hypothermia:

Ryan D Hollenbeck1, Quinn Wells, Jeremy Pollock

  • 1Vanderbilt University Medical Center, Nashville, TN 37232, USA.

Critical Pathways in Cardiology
|July 25, 2012
PubMed

Insights

Implementing the CODE ICE pathway significantly reduced the time to initiate therapeutic hypothermia (TH) and reach target temperatures in cardiac arrest survivors. Further studies are needed to assess its impact on clinical outcomes.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Neurology

Background:

  • Out-of-hospital cardiac arrest (OHCA) has high mortality, with neurologic injury being a primary cause of death in survivors.
  • Therapeutic hypothermia (TH) is a recommended treatment for comatose cardiac arrest survivors to mitigate neurologic injury.
  • Implementing standardized TH protocols requires a multidisciplinary approach and can be challenging.

Purpose of the Study:

  • To evaluate the impact of a revised institutional protocol, "CODE ICE," on the timeliness of therapeutic hypothermia initiation and target temperature achievement in cardiac arrest patients.
  • To assess the integration of therapeutic hypothermia with regional ST-elevation myocardial infarction networks.

Main Methods:

  • A retrospective analysis of 150 consecutive comatose cardiac arrest victims treated with TH before (n=82) and after (n=68) the CODE ICE implementation (2007-2011).
  • CODE ICE involved a multidisciplinary team, burst paging, computerized physician support, and integration with the STEMI network.

Main Results:

  • The mean time to TH initiation decreased from 306 ± 165 minutes pre-CODE ICE to 196 ± 144 minutes post-CODE ICE (P < 0.001).
  • The mean time to reach target temperature decreased from 532 ± 214 minutes to 392 ± 215 minutes (P < 0.001).
  • No significant changes in survival or neurologic outcome at hospital discharge were observed.

Conclusions:

  • The CODE ICE pathway effectively reduced the time to initiate TH and achieve target temperatures in cardiac arrest survivors.
  • While CODE ICE improved process metrics, further research is necessary to determine its effect on long-term clinical outcomes like survival and neurologic recovery.

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