BRR

Purpose

To identify ALL patients who are treated with therapeutic hypothermia following a Cardiac Arrest Witnessed 100-2 or Cardiac Arrest Unwitnessed 100-1. By identifying all patients that receive this therapy a further audit can be done to identify if therapy was appropriate or not.

• reviewed with Kendiss Olafson and Dean Bell.--TOstryzniuk 17:58, 26 August 2009 (CDT)

Code used

BRR is a ICU Var 2 tag that we use in our database for ICU patients who have been placed on the Cardiac Arrest Cooling Protocol

• BRR - stands for "Brrrr" as in shivering or cold.

Possible values

• BRR - mean cooling protocol applied for Witnessed Cardiac Arrest (started August 2004) or Unwitnessed Cardiac Arrest (August 27.09)
• XBR - means no cooling protocol applied for Witnessed Cardiac Arrest (Added March 19.09) or Unwitnessed Cardiac Arrest

Post-Arrest cooling only

Var code BRR is not to be applied when a cooling protocol is used to normalize temperature for non-arrested patients.

Cardiac Arrest Cooling Protocol

• Target temp: 32°C to 34°C for 12 to 24 hours.

Taken from the Hypothermia Protocol:

• Cooling is indicated if all of the following are checked:
  • Witnessed or Unwitnessed 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)

Discussion

• I added the unwittnessed here even though it's likely not part of the protocol. Don't want to get anyone confused...Ttenbergen 10:40, 27 August 2009 (CDT)
• Is the cooling protocol given as a coding aid, i.e. is BRR only supposed to be coded if all of the above are met? Or else, is BRR to be coded if cooling was done post-arrest, even if one of the indications is missing? I suspect the former. If so, this should be clarified in here. This could be done by moving the protocol into a "context" section at the bottom of the article. Ttenbergen 10:40, 27 August 2009 (CDT)

Data Integrity Rules

If Cardiac Arrest Witnessed 100-2 or Cardiac Arrest Unwitnessed 100-1 in admit or complications diagnosis field then both the following must also be marked:

• ICU Var 2 – “BRR” or “XBR”
• TISS item T6-hypothermia/hyperthermia blanket
• changes made.--TOstryzniuk 17:58, 26 August 2009 (CDT)

Purpose of marking BRR or BRX

By marking BRR or BRX for all patients with the diagnosis of witnessed cardiac arrest (100-2) or unwitnessed cardiac arrest (100-1), collectors will have verified at the time of collection that they did not miss marking that a patient was placed on the cooling protocol. This will eliminate the query that gets send back to collectors to double check this item.