Impact of a targeted temperature management quality improvement project on survival and neurologic outcomes in cardiac arrest patients

Thung-Hsien Hsu; Wei-Chun Huang; Kun-Chang Lin; Chieh-Ling Huang; Hsiao-Yun Tai; Yi-Ching Tsai; Meng-Chen Wu; Yun-Te Chang

doi:10.1097/JCMA.0000000000000939

Impact of a targeted temperature management quality improvement project on survival and neurologic outcomes in cardiac arrest patients

J Chin Med Assoc. 2023 Jul 1;86(7):672-681. doi: 10.1097/JCMA.0000000000000939. Epub 2023 Jul 5.

Authors

Thung-Hsien Hsu¹, Wei-Chun Huang^{2

3}, Kun-Chang Lin², Chieh-Ling Huang⁴, Hsiao-Yun Tai⁵, Yi-Ching Tsai⁵, Meng-Chen Wu², Yun-Te Chang^{1

6

7

8}

Affiliations

¹ Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
² Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
³ Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC.
⁴ Department of Quality Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
⁵ Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
⁶ School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
⁷ Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC.
⁸ Department of Emergency & Critical Care Medicine, Pingtung Veterans General Hospital, Pingtung, Taiwan, ROC.

PMID: 37220417
DOI: 10.1097/JCMA.0000000000000939

Abstract

Background: Targeted temperature management (TTM) is recommended for postresuscitation care of patients with sudden cardiac arrest (SCA) and its implementation remains challenging. This study aimed to evaluate the newly designed Quality Improvement Project (QIP) to improve the quality of TTM and outcomes of patients with SCA.

Methods: Patients who experienced out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) with return of spontaneous circulation (ROSC) and were treated in our hospital between January 2017 and December 2019 were enrolled retrospectively. All included patients received QIP intervention initiated as follows: (1) Protocols and standard operating procedures were created for TTM; (2) shared decision-making was documented; (3) job training instruction was created; and 4) lean medical management was implemented.

Results: Among 248 included patients, the postintervention group (n = 104) had shorter duration of ROSC to TTM than the preintervention group (n = 144) (356 vs 540 minutes, p = 0.042); better survival rate (39.4% vs 27.1%, p = 0.04), and neurologic performance (25.0% vs 17.4%, p < 0.001). After propensity score matching (PSM), patients who received TTM (n = 48 ) had better neurologic performance than those without TTM (n = 48) (25.1% vs 18.8%, p < 0.001). OHCA (odds ratio [OR] = 2.705, 95% CI: 1.657-4.416), age >60 (OR = 2.154, 95% CI: 1.428-3.244), female (OR = 1.404, 95% CI: 1.005-1.962), and diabetes mellitus (OR = 1.429, 95% CI: 1.019-2.005) were negative predictors of survival; while TTM (OR = 0.431, 95% CI: 0.266-0.699) and bystander cardiopulmonary resuscitation (CPR) (OR=0.589, 95% CI: 0.35-0.99) were positive predictors. Age >60 (OR= 2.292, 95% CI: 1.58-3.323) and OHCA (OR= 2.928, 95% CI: 1.858-4.616) were negative predictors of favorable neurologic outcomes; while bystander CPR (OR=0.572, 95% CI: 0.355-0.922) and TTM (OR=0.457, 95% CI: 0.296-0.705) were positive predictors.

Conclusion: A new QIP with defined protocols, documented shared decision-making, and medical management guidelines improves TTM execution, duration from ROSC to TTM , survival, and neurologic outcomes of cardiac arrest patients.

MeSH terms

Cardiopulmonary Resuscitation* / methods
Female
Humans
Hypothermia, Induced* / adverse effects
Hypothermia, Induced* / methods
Out-of-Hospital Cardiac Arrest* / therapy
Quality Improvement
Retrospective Studies