Nurses Help Introduce, Develop, and Implement Cutting-Edge Hypothermia Therapy for Cardiac Arrest Patients
When introducing new therapies, involving nurses throughout the policy development and implementation is a key factor in its success.
In the fall of 2008, Karen Canning, RN, MSN, then a nurse educator at Crozer-Chester Medical Center’s Emergency Department and now clinical director of 2 North at Crozer-Chester, attended a SEACCA conference and heard a physician speak about the use of hypothermia therapy after a cardiac arrest.
“I was really interested in this, wondering if we could do this at Crozer. I approached the physician, who was part of the American Heart Association Advisory Committee, to ask him what I could do to see the protocol adopted at our health system,” Canning says.
She took his advice and found a physician to champion the idea — Gary Wendell, M.D., a pulmonologist and intensivist with the ICU. Canning pulled together available research, protocols, and other materials to develop a proposal for the therapy and they assembled a team of nurses, physicians, and staff from the Emergency Department, Critical Care, the Paramedics Department, and various hospitals to develop the process for implementing this powerful evidence-based therapy.
“The use of the therapeutic hypothermia can minimize brain damage that is likely to occur when patients survive cardiac arrest,” says Canning, who also has been instrumental in the implementation at the hospital. “Along with better neurological outcomes, patients who are ‘cooled’ may also have an increased survival rate. It’s also a nurse-driven protocol, which is timing is critical.”
About the therapy
Studies have shown that rapidly reducing a patient’s body to a core temperature of about 33°C (91.4°F) for 12-24 hours following a cardiac arrest helps neurological recovery later.
The theory is that the cold reduces the body’s need for oxygen and slows the deadly chemical cascade that sets in when oxygen isn’t circulating because the heart stopped beating. The procedure is limited to patients who go into cardiac arrest in the emergency room or during a hospital admission and who are comatose, are 18 years or older, and who do not have a Do Not Resuscitate (DNR) order, a terminal illness, or bleeding due to an injury or trauma.
Patients are first cooled through the use of injected saline, and then their chests and legs are wrapped with special blankets that are hooked up to a cooling machine. The process reduces the patient’s core body temperature to about 33°C (91.4°F) for up to 24 hours. After, the patient is gently re-warmed back to a normal temperature.
Nurses’ roles in implementing the therapy and refining it
The therapy was first introduced at Crozer, and then at Delaware County Memorial Hospital and Taylor Hospital through in-service training for ICU and Emergency Department nurses, physicians and staff.
Putting the therapy into action involves a large team: the patient’s nurse, the department physician, the department charge nurse, the cardiologist, a support nurse, the nurse director of the department, and the nurse supervisor. Because it’s a low volume/high risk therapy, a lot of support is critical. Nurses typically are the first responders for in-hospital patients who have a cardiac arrest, so their quick assessment of the patient’s condition and how it fits the protocol criteria is crucial. If nurses determine that the protocol is appropriate, they do a telephone consult with the cardiologist and start implementing the therapy by injecting the cooled saline solution while the physician is en route to the patient’s room.
“The therapy requires a team approach to patient care, versus the silo effect where physicians give the orders and the nurses carry them out,” says Alisha Hartunian, RN, BSN, at Taylor Hospital.
Afterwards, a patient debriefing meeting with all involved in the procedure focus on what worked, what didn’t, and what needs to be followed up on. “We’re tweaking the order set to make it more user friendly for the nurses. It’s part of our ongoing quality assurance process,” she says.
Nurses’ roles in educating about therapy at CKHS and beyond
Nurses have been instrumental in sharing research about the therapy and educating their peers, says Pat LaPorta RN, MS, BSN, CCRN, who has a BC in cardiovascular nursing and is Critical Care Educator at Delaware County Memorial Hospital.
On Oct. 12, 2010, Marsha Doney, RN, BSN, CCRN, and staff nurse CICU at DCMH, participated in two presentations about the therapy at CKHS. The first was the keynote presentation at the 5th Annual CKHS Nursing Research Symposium, where Doney presented along with Jessica Wheaton, RN, staff nurse, MICU, at Crozer. The second presentation was on Oct. 26, at DCMH’s Second Annual Nursing Update meeting, which was attended by about 60-70 nurses from throughout the health system. Doney presented along Maryjo Kernaghan, nursing educator and staff nurse of the DCMH Emergency Department, and paramedic Scott Dunbar.
Crozer-Keystone is also participating in the Hyperthermia Cardiac Arrest Registry out of the University of Pennsylvania. LaPorta is the principal investigator for DCMH and will be sharing critical data about patients who undergo the therapy, from their criteria for selection through vital milestones throughout the therapy, and then how they do during recovery, discharge, and afterwards.
So far, the results of the therapy are trending higher than cardiac arrest patients without the hypothermia therapy. Recently, the American Heart Association’s International 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care reported that cardiac arrest patients have a 6 percent success rate. So far, DCMH’s post-cardiac arrest success rate for patients who get the therapy is around 25 percent.
“Nurses are the ones putting proven therapies into practice at the bedside,” says LaPorta. “Once you educate nurses on the whys and wherefores of the therapy, share the research with them, and how it all works, they will believe in it to get the outcomes you want, which is for the patient to survive and be discharged as healthy as possible.