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'''BRR/XBR''' is an entry we use to identify whether patients are receiving therapeutic hypothermia following a '''cardiac arrest'''. By identifying all patients that receive this therapy a further audit can be done to identify if therapy was appropriate or not.
{{LegacyContent
|explanation=Will be included in ICD10
|successor=[[Targeted Temperature Management (TTM)]]
|content=
 
[[Task Team Meeting - Rolling Agenda and Minutes#ICU Database Task Group Meeting – November 8, 2018 | DB task meeting minutes Nov 8.18]]-- User:TOstryzniuk|Trish Ostryzniuk]] 13:41, 2018 December 24 (CST) -->
 
{{Project
| Project = {{PAGENAME}}
| ProjectActive = active
| ProjectProgram = CC
| ProjectRequestor = Dr. Dean Bell/Dr. Kendiss Olafson
}}
 
{{TT | question =
* start and stop date should be in table? [[User:TOstryzniuk|Trish Ostryzniuk]] 13:56, 2018 December 24 (CST)
** yes, it's somewhere on my list to change all the tmp project templates to have the dates built in. Tagged now so staying on the list. }}
 
'''BRR/XBR''' is an entry we use to identify whether patients are receiving therapeutic hypothermia [[Targeted Temperature Management (TTM)]] following a '''cardiac arrest''' according to the [[Cardiac Arrest Cooling Protocol]]. By identifying all patients that receive this therapy a further audit can be done to identify if therapy was appropriate or not.
We do '''not track cooling for reasons other than cardiac arrest'''.
We do '''not track cooling for reasons other than cardiac arrest'''.


=={{G | Guidelines}} / Collection Instructions ==
== Guidelines / Collection Instructions ==
For any ICU patient with one of the following diagnoses:  
For any ICU patient with one of the following diagnoses:  
* [[Witnessed Cardiac Arrest | Cardiac Arrest Witnessed 100-2]]  
* [[Cardiac arrest]]
* [[Unwitnessed Cardiac Arrest | Cardiac Arrest Unwitnessed 100-1]]   
 
code in TMP follows:  
or pre-ICD10:
* Project: Cooling
* [[Witnessed Cardiac Arrest]]  
* [[Unwitnessed Cardiac Arrest]]   
 
Code in TMP follows:  
* Project: Cooling  
*item
*item
**'''BRR''' (BRR stands for "Brrrr" as in shivering or cold)
**'''BRR''' (BRR stands for "Brrrr" as in shivering or cold)
*** cooling protocol was applied >= 12 hrs
*** cooling protocol was applied at any point post arrest
*** cooled for >= 12 hrs prior to arrival to your ICU
**'''XBR''' - no cooling protocol applied
**'''XBR''' - no cooling protocol applied, or applied for < 12hrs
** '''Do not code BRR or XBR''' when a cooling protocol is used to normalize temperature for any type of '''non-cardiac arrest''' patients.
 
We want to capture all patients who are cooled post '''cardiac arrest''' '''''whether they meet criteria or not'''''.  A significant portion of patients following cardiac arrest do not meet ALL the criteria  listed in this article however, based on the available evidence it is reasonable to consider cooling them.


==Context: Cardiac Arrest Cooling Protocol==
'''Do not code BRR or XBR''' when a cooling protocol is used to normalize temperature for any type of '''non-cardiac arrest''' patients.
Target temp: '''32°C to 34°C''' for 12 to 24 hours (but see [[#Guidelines|above]] for our collection threshold).


Taken from the Hypothermia Protocol - Criteria:
== CCI ==
*Cooling is indicated if '''all''' of the following are checked: 
[[Task Team Meeting - Rolling Agenda and Minutes#ICU Database Task Group Meeting – October 3, 2018]] confirmed that we can stop collecting this when we start collecting CCI [[Targeted Temperature Management (TTM)]]. We may want to import the old entries as CCI codes? Ttenbergen 00:19, 2018 October 10 (CDT)
**Cardiac Arrest
**Initial rhythm ventricular fibrillation/tachycardia(Dx code: 131-4, or 131-1)
**Time to ACLS <15 minutes
**Total ACLS time <60 minutes
**Persistent [[Glasgow Coma Scale]] < or = 9
**Systolic BP currently over 90 mmHg (pressors allowed)
**< 8 hours elapsed since Return of Spontaneous Circulation (ROSC)


== {{CCMDB Data Integrity Checks}} ==
== Cross Checks ==
see [[Check BRR/XBR vs cardiac arrest dx]]
see [[Check BRR/XBR vs cardiac arrest dx]]


== Background ==
== Background ==
== Start Dates ==
=== '''Start Dates''' ===
* collection was started '''August 2004'''
* '''2004 August'''
* XBR and [[CCMDB.mdb]] cross checks were added to detect occasions where entry was just forgotten/missed '''March 19.09'''
* XBR and [[CCMDB.accdb]] cross checks were added to detect occasions where entry was just forgotten/missed '''March 19.09'''
* reviewed with Kendiss Olafson and Dean Bell.--[[User:TOstryzniuk|TOstryzniuk]] 17:58, 26 August 2009 (CDT)
* reviewed with Kendiss Olafson and Dean Bell.--[[User:TOstryzniuk|TOstryzniuk]] 17:58, 26 August 2009 (CDT)
* cross-checks changed to include [[Unwitnessed Cardiac Arrest]] '''August 27.09'''  
* cross-checks changed to include [[Unwitnessed Cardiac Arrest]] '''August 27.09'''  
* moved from ICU Var 2 into TMP on Dec 18, 2014
* moved from ICU Var 2 into TMP on Dec 18, 2014
=== '''Stop Date''' ===
'''2018 Dec 31'''
*Stop in TMP.  All patient still in unit after this date, code as: [[Targeted Temperature Management (TTM)]]


=== Why the code XBR? ===
=== Why the code XBR? ===
The rationale for the code XBR is to identify those patients who had a cardiac arrest but '''were not cooled''' regardless if they met criteria for cooling or not. XBR was implemented after an audit of cardiac arrest was done and it was found that there were several cardiac arrests coded that were missing code BRR.  By leaving Variable 2 blank for a cardiac arrest, it is not clear to Kendiss or Julie whether a data collector missed tagging it or if indeed cooling was not applied.  Coding XBR indicates to both Kendiss and Julie that a collector verfied that the cooling protocol was not applied.   
The rationale for the code XBR is to identify those patients who had a cardiac arrest but '''were not cooled''' regardless if they met criteria for cooling or not. XBR was implemented after an audit of cardiac arrest was done and it was found that there were several cardiac arrests coded that were missing code BRR.  By leaving Variable 2 blank for a cardiac arrest, it is not clear to Kendiss or Julie whether a data collector missed tagging it or if indeed cooling was not applied.  Coding XBR indicates to both Kendiss and Julie that a collector verfied that the cooling protocol was not applied.   


== Should this be an ongoing collection? ==
=== removed 12 hr requirement ===
"...As you can see it is a challenge to keep criteria straight for even this one project here.  The question needs to be asked of the Critical Care Quality Improvement team, Kendiss Olafson & Dave Easton (chairman) if BRR and XBR really needs to be collected indefinitely or if it can be done as an intermittent audit.  I will pose the question to Dave and Kendiss and/or raise it at next Steering Committee meeting.
Discussed at task 2018-04-11: we are removing the 12 hr requirement because the use and application of the protocol has changed since inception and this restriction is no longer reasonable.  
*June 19.12 - Email sent to QI Team (Olafson & Easton), Critical Care Directors HSC (Paunavic, Tweed, Garland)as to above.[[User:TOstryzniuk|Trish Ostryzniuk]] 12:48, 2012 June 19 (CDT)
**Response from: Kendiss Olfson & Dave Easton who is the Chairman of CCQI committee - they will be meeting in August 2012 and let us know the status of this. Continue collecting until we hear back.[[User:TOstryzniuk|Trish Ostryzniuk]] 14:22, 2012 June 22 (CDT)
*** any news on that? Ttenbergen 00:43, 2012 November 2 (EDT)
**** none.[[User:TOstryzniuk|Trish Ostryzniuk]] 13:06, 2014 December 2 (CST)
***** now?{{discussion}}


== Related articles ==
{{Related Articles}}


[[Category: ICU Variable Codes]]
[[Category:Project ICU only]]
[[Category: Arrest]]
[[Category:Arrest]]
}}

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