EBP Project Abstract
Appraised by:
Shannon Ware, SN, LeeDawn Snider, SN & Marina Weltikol, SN
(NDSU Nursing at Sanford Health, Bismarck, ND)
Clinical Question:
After cardiac arrest, does the use of hypothermic therapy decrease neurological deficits?
Articles:
Avery, K., O’brien, M., Pierce, C., & Gazarian, P. (2015). Use of a nursing checklist to
facilitate implementation of therapeutic hypothermia after cardiac arrest. American
Association of Critical-Care Nurses, 35(1):29-38. doi: 10.4037/ccn2015937
The Hypothermia after Cardiac Arrest Study Group (2002). Mild therapeutic hypothermia to
improve the neurologic outcome after cardiac arrest. The New England Journal of
Medicine, 8 (346), 549-556. doi: 10.1056/NEJMoa012689
Holzer, M., Bernard, S., Hachimi-Idrissi , S., Risto, R., & Sterz, F. (2005). Hypothermia for
neuroprotection after cardiac arrest: systematic review and individual patient data
meta-analysis. Critical Care Medicine, 414-418.
Kozak, T. (2007). Induced hypothermia for patients with cardiac arrest: role of a clinical
nurse specialist. Critical Care Nurse; 27(5):36-39.
Wang, X., Lin, Q., Zhao, S., Lin, S. & Chen, F. (2013) Therapeutic benefits of mild
hypothermia in patients successfully resuscitated from cardiac arrest: a meta-analysis.
World J Emerg Med, 3 (4):260-265. doi: 10.5847/wjem.j.issn. 19208642.2013.04.20
Synthesis of Evidence:
A meta-analysis by Wang, Lin, Zhao, Lin and Chen (2013) reviewed the effectiveness
and safety of therapeutic mild hypothermia in patients successfully resuscitated from cardiac
arrest. The strength of the article is a level 1 meta-analysis four different randomized controlled
trials were used. The meta-analysis concluded that therapeutic mild hypothermia improved
neurological function, is safe and beneficial for cardiac arrest patients. Due to the limitations in
the study being the inadequate number of trial and study size, as well as fewer trials and cases,
more high quality studies and adequate cases should be required for further evaluation and
validity.
A second study by Hypothermia after Cardiac Arrest Study Group was a randomized
controlled trial. The purpose of the study was to show “whether mild systemic hypothermia
increases the rate of neurologic recovery after resuscitation from cardiac arrest due to ventricular
fibrillation” (Hypothermia Group, 2002, p. 549). It was a trial with 137 patients receiving
hypothermia therapy and 138 with normothermia therapy, making a total of 275 patients
participating in the study. The study was well controlled and it provided definitive results. The
study concluded that after being successfully resuscitated after cardiac arrest, therapeutic mild
hypothermia improved neurological outcome and mortality.
An additional study was a systematic review by Holzer, Bernard, Hachimi-Idrissi, Roine,
& Sterz (2005). This review consisted of three randomized trials which were used pertaining to
the main criteria of hypothermic therapy being implemented after successful resuscitation of
patients in cardiac arrest. The main goal was to assess whether induced hypothermia improved
neurologic recovery in survivors of primary cardiac arrest. It looked primarily at what possible
short-term and long-term neurological damage was endured while in cardiac arrest and
concluded that hypothermia improves short term neurologic recovery and survival in patients
resuscitated from cardiac arrest of presumed cardiac origin. However, they felt that the long term
effects needed further research (Holzer et al, 2005).
Bottom Line (findings):
The research shows that hypothermic therapy does in fact decrease neurological deficits
in cardiac arrest patients.
Implications for Nursing Practice:
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Provide presentation to healthcare staff on the impact of hypothermic therapy use
Develop a protocol or policy for induced hypothermic therapy
Demonstrate hypothermic therapy through simulations and trainings
Develop a nursing care plan for hypothermic therapy patients