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'''Cardiac Arrest Cooling Protocol''' for ICU patients.
{{LegacyContent
|explanation=Will be included in ICD10
|successor=[[Targeted Temperature Management (TTM)]]
|content=


*If the cooling protocol is started on a patient who has had a cardiac arrested, the code '''BRR''' must be marked in [[ICU Var 2]].
[[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) -->
*If ICU Var 2 is marked '''BRR''' then TISS item [[TISS Neurological | T6]] must also be marked.


{{Project
| Project = {{PAGENAME}}
| ProjectActive = active
| ProjectProgram = CC
| ProjectRequestor = Dr. Dean Bell/Dr. Kendiss Olafson
}}


*Target temp: 32°C to 34°C for 12 to 24 hours.
{{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. }}


*Code is not to be applied when a cooling protocol is used to normalize temperature for non-arrested patients.
'''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'''.


Taken from the Hypothermia Protocol:
== Guidelines / Collection Instructions ==
*Cooling is indicated if ALL of the following are checked:
For any ICU patient with one of the following diagnoses:  
**Witnessed Arrest
* [[Cardiac arrest]]
**Initial rhythm ventricular fibrillation/tachycardia
**Time to ACLS <15 minutes
**Total ACLS time <60 minutes
**Persistent GCS < or = 9
**Systolic BP currently over 90 mmHg (pressors allowed)
**< 8 hours elapsed since Return of Spontaneous Circulation (ROSC)
--[[User:LKolesar|LKolesar]] 13:54, 22 January 2009 (CST)
--[[User:TOstryzniuk|TOstryzniuk]] 20:37, 26 January 2009 (CST)


or pre-ICD10:
* [[Witnessed Cardiac Arrest]]
* [[Unwitnessed Cardiac Arrest]] 


Possible Value:  
Code in TMP follows:  
'''BRR''' if the protocol was applied.
* Project: Cooling
*item
**'''BRR''' (BRR stands for "Brrrr" as in shivering or cold)
*** cooling protocol was applied at any point post arrest
**'''XBR''' - no cooling protocol applied


[[User:TOstryzniuk|TOstryzniuk]] 16:19, 22 July 2008 (CDT)
'''Do not code BRR or XBR''' when a cooling protocol is used to normalize temperature for any type of '''non-cardiac arrest''' patients.


===Integrity Check===
== CCI ==
*SUGGESTION for updated version of CCMDB: look here:[[CCMDB.mdb_Change_Log_2009#ICU_Var2:_BRR_.26_Complication_DX_code_of_Cardiac_Arrest |Suggestion for Catching missed BRR in ACCESS]].--[[User:TOstryzniuk|TOstryzniuk]] 16:03, 28 January 2009 (CST)
[[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)


[[Category: ICU Variable Codes]]
== Cross Checks ==
see [[Check BRR/XBR vs cardiac arrest dx]]
 
== Background ==
=== '''Start Dates''' ===
* '''2004 August'''
* 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)
* cross-checks changed to include [[Unwitnessed Cardiac Arrest]] '''August 27.09'''
* 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? ===
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. 
 
=== removed 12 hr requirement ===
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.
 
== Related articles ==
{{Related Articles}}
 
[[Category:Project ICU only]]
[[Category:Arrest]]
}}

Latest revision as of 16:07, 2020 May 5

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DB task meeting minutes Nov 8.18-- User:TOstryzniuk

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