Hollenbeck Ryan D, Wells Quinn, Pollock Jeremy, Kelley Michael B, Wagner Chad E, Cash Michael E, Scott Carol, Burns Kathy, Jones Ian, Fredi Joseph L, McPherson John A
Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Crit Pathw Cardiol. 2012 Sep;11(3):91-8. doi: 10.1097/HPC.0b013e31825b7bc3.
Out-of-hospital cardiac arrest is common and is associated with high mortality. The majority of in-hospital deaths from resuscitated victims of cardiac arrest are due to neurologic injury. Therapeutic hypothermia (TH) is now recommended for the management of comatose survivors of cardiac arrest. The rapid triage and standardized treatment of cardiac arrest patients can be challenging, and implementation of a TH program requires a multidisciplinary team approach. In 2010, we revised our institution's TH protocol, creating a "CODE ICE" pathway to improve the timely and coordinated care of cardiac arrest patients. As part of CODE ICE, we implemented comprehensive care pathways including measures such as a burst paging system and computerized physician support tools. "STEMI on ICE" integrates TH with our regional ST-elevation myocardial infarction network. Retrospective data were collected on 150 consecutive comatose cardiac arrest victims treated with TH (n = 82 pre-CODE ICE and n = 68 post-CODE ICE) from 2007 to 2011. After implementation of CODE ICE, the mean time to initiation of TH decreased from 306 ± 165 minutes to 196 ± 144 minutes (P < 0.001), and the time to target temperature decreased from 532 ± 214 minutes to 392 ± 215 minutes (P < 0.001). There was no significant change in survival or neurologic outcome at hospital discharge. Through the implementation of CODE ICE, we were able to reduce the time to initiation of TH and time to reach target temperature. Additional studies are needed to determine the effect of CODE ICE and similar pathways on clinical outcomes after cardiac arrest.
院外心脏骤停很常见，且死亡率很高。心脏骤停复苏患者在院内死亡的主要原因是神经损伤。目前推荐对心脏骤停昏迷幸存者进行治疗性低温（TH）。对心脏骤停患者进行快速分诊和标准化治疗具有挑战性，实施TH方案需要多学科团队协作。2010年，我们修订了本机构的TH方案，创建了“冰代码（CODE ICE）”路径，以改善心脏骤停患者的及时和协调护理。作为冰代码的一部分，我们实施了综合护理路径，包括诸如突发传呼系统和计算机化医师支持工具等措施。“冰上ST段抬高型心肌梗死（STEMI on ICE）”将TH与我们的区域ST段抬高型心肌梗死网络相结合。收集了2007年至2011年期间150例接受TH治疗的连续昏迷心脏骤停患者的回顾性数据（冰代码前n = 82例，冰代码后n = 68例）。实施冰代码后，开始TH的平均时间从306±165分钟降至196±144分钟（P < 0.001），达到目标温度的时间从532±214分钟降至392±215分钟（P < 0.001）。出院时的生存率或神经功能结局无显著变化。通过实施冰代码，我们能够缩短开始TH的时间和达到目标温度的时间。需要进一步研究以确定冰代码及类似路径对心脏骤停后临床结局的影响。
