Raj Nichani Blackpool Victoria Hospital

 Strengthen collaboration across the region  Spread good practice  Develop on the tremendous potential that exists.

 Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of- hospital 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 of our practice in Blackpool  Good success with the use of therapeutic hypothermia

 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 of variation  Do 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 ˚C per-hour to 36.5˚C.

 Central database  Hopefully move to a Web based system  Data anonymised prior to submission, processed and fed back

 Time to initiation of cooling

 Target temp reached

 Feedback to hospital D

 Clinically relevant  Collaborative Audit – Larger patient numbers  Trainee 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 of resources  Links with other networks -

 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