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Principal Investigators: Morrison, Laurie (St. Michael's Hospital); Dorian, Paul (St. Michael's Hospital); Scales, Damon (Sunnybrook Health Sciences Centre).
A. Statement of the health problem
A cardiac arrest occurs when the heart stops beating and will result in death if the patient fails to respond to treatment within the first 5-10 minutes. Unfortunately, despite the best care provided by first responders, most patients who survive a cardiac arrest end up with brain injury. About 60% of successfully resuscitated victims of a cardiac arrest regain consciousness but of these, 33% experience irreversible brain damage. There is sufficient evidence to support cooling patients to a very low body temperature until the blood supply to the brain has been restored. This treatment reduces brain injury and has become a recommended therapy for patients who are successfully resuscitated after cardiac arrest. This treatment is termed mild therapeutic hypothermia. Significant research has been done on its use in clinical settings.
Despite the strong research evidence showing that this treatment works and is easy to use, recent surveys show that hypothermia is delivered inconsistently, incompletely, and with unnecessary in-hospital delays. Only 26% of physicians (US and Canada) and 26% of hospitals (UK) regularly use a hypothermia protocol.
Our objective is to improve the use of hypothermia as part of the post-resuscitation care for patients who experience a cardiac arrest and have been successfully resuscitated by paramedics in outside of hospitals and are brought to the local hospital for further treatment.
We will create a network of southern Ontario hospitals who receive and treat out-of-hospital cardiac arrest patients and who are interested in learning from each other to improve this treatment. We will provide the hospitals with educational materials and tools and a forum to ask questions and share their knowledge and experience. We will measure what they do and how they do it and evaluate whether this approach to standardizing care makes a difference on their every day practice. We hope that standardizing care in a way that is tailored to the institution and staff will improve the quality of care and lead to better patient outcomes. Our focus is on helping the staff in each hospital to easily put their hands on the right tools to perform hypothermia immediately on arriving at the patient’s bedside – making the right thing to do the easiest thing to do.
D. Unique / Innovative aspect
Due to the nature of our provincial health care system and busy day-to-day operations of the emergency and intensive care units, it is rare for hospitals to work together to standardize and share their treatment protocols and educational resources. Our approach to create a network of hospitals to do just that will enable us to leverage new and creative strategies to share knowledge and tools. Although our project focuses on therapeutic hypothermia, the required network infrastructure will allow easy implementation of future studies, in much the same manner as proposed in our study, on other treatment strategies (e.g., lung, blood pressure, ect).
E. Relevance to the objectives of Resuscitation and Knowledge Transfer initiative
Our project is specifically designed to help doctors and nurses apply scientific knowledge to their practice through a sustainable “community of sharing”. The community of participating hospitals and staff that make up the SPARC network share a common goal of improving patient outcomes. The information gathered will contribute to the 2010 Resuscitation Guidelines, providing evidence on strategies for using therapeutic hypothermia and provide a model for implementing and evaluating other recommended treatments in these guidelines.
Our study will also contribute to the current international discussions that changing practice to improve outcome requires science, education, and tools for action. It is not enough to define how to treat patients. To make a difference in outcome, we must translate the knowledge into changing practice at the bedside.