Raj Nichani
Blackpool Victoria Hospital

Strengthen collaboration across the region
 Spread
good practice
 Develop
exists.
on the tremendous potential that

Bernard SA, Gray TW, Buist MD, et al.
Treatment of comatose survivors of out-ofhospital 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.
 How
good are we with putting this evidence
into clinical practice.
 Do
we achieve similar results outside the
settings of RCT’s.
 Audit
 Good
of our practice in Blackpool
success with the use of therapeutic
hypothermia
Outcomes
12
10
died during
cooling
inadequately
cooled
not cooled
8
6
4
2
VF
ie
d
D
VF
su
rv
iv
ed
0
cooled
 All
survivors were discharged with good
neurological recovery
 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?
 Are
patients being subjected to unacceptable
variations in practice?
 Source
 Do
of variation
these variations influence outcome?
 Clear
and defined
 Unequivocal
 Key
individuals met and agreed on basic
standards.
 All
4 hospitals represented
 Proforma
and Database created

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.
 Central
database
 Hopefully
 Data
move to a Web based system
anonymised prior to submission ,
processed and fed back
 Time
to initiation of cooling
10
9
8
7
6
5
4
3
2
1
0
hours
hospital Hospital Hospital Hospital
A
B
C
D
 Target
temp reached
8
7
6
5
YES
NO
4
3
2
1
0
hosp A
hosp B
hosp C
hosp D
8
7
6
5
4
hours
3
2
1
0
hospital Hospital Hospital Hospital
A
B
C
D
 Feedback
to hospital D
10
9
8
7
6
5
4
3
2
1
0
all hosptals
hospital D
JANMARCH
APRJUN
JULSEPT
OCTDEC
 Clinically
relevant
 Collaborative
numbers
 Trainee
Audit – Larger patient
involvement
 Potential
to spread to other regions
 Generating
a large valuable local
database of patients.
 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
 Incentive
for units to drive up their
performance.
 Funding
 Links
of resources
with other networks -
The European Resuscitation Council Hypothermia
After Cardiac Arrest Registry Study Group
 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