Implementation of Multi-Point Access Targeted Temperature Management (TTM) in Post Cardiac Arrest Patients

Purpose:
Healthcare systems are faced with the devastating effects of post-cardiac arrest brain injuries. Identification and implementation of neurologic and cardio-protective treatment modalities decrease necessary patient resources and increase the functional outcomes of patients at discharge.

Significance:
In the United States, more than 300,000 people suffer out of hospital cardiac arrest annually. In 2010, American Heart implemented a recommendation to “consider hypothermia” in survivors of cardiac arrest. The neurological complexity of post-resuscitation care indicates TTM for optimal outcomes.

Strategy and Implementation:
Methodist Hospitals implemented TTM March 15, 2012. Successful implementation of evidence-based interventions is many times very difficult, but is crucial for the clinical staff to ensure the quality and safety of patient care. Once our TTM program (Code Ice) was developed, reviewed and approved; successful implementation in critical care areas (Cath Lab/ED/ICU) was the primary goal. Staff attended a 4 hour didactic session on the critical components of TTM (induced hypothermia, maintenance and controlled re-warming). The first two hours of the session focused on the evidence supporting TTM and then introduced staff to the policy, order sets, and the three phases of TTM. The last two hours of the didactic session was simulation based which gave staff hands on practice with all necessary equipment. Competency was assessed and verified during the simulation session. Staff did verbalize fear and skepticism about the process; but where informed of all support systems available.

Evaluation:
Methodist Hospital has treated 30 “Code Ice” patients since implementation. “Code Ice” patients that survive to discharge display a trend of improved neurologic outcome with an average modified Rankin score of 2.2. This is a 39% improvement in functional state compared to before TTM implementation.

Implications for Practice:
Health care is in evolution and bringing evidence based practice programs to the bedside will increase patient quality outcomes. TTM does improve neurological outcomes in cardiac arrest survivors and decreases the need for long term complex patient care.