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.

Guidelines

For any ICU patient with a witnessed or unwitnessed cardiac arrest, code the Var2 variable as follows:

• BRR - cooling protocol was applied (BRR stands for "Brrrr" as in shivering or cold)
  • Note: Do not code BRR when a cooling protocol is used to normalize temperature for non-arrested patients!
• XBR - means no cooling protocol applied for cardiac arrest patient
  • by coding XBR rather than leaving the variable empty we can automatically cross check that this was not just missed

Context: 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:
  • 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)

[1]

Discussion

• 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)

Historical Info

• collection was started August 2004
• XBR and CCMDB.mdb cross checks were added to detect occasions where entry was just forgotten/missed March 19.09)
• reviewed with Kendiss Olafson and Dean Bell.--TOstryzniuk 17:58, 26 August 2009 (CDT)
• cross-checks changed to include Unwitnessed Cardiac Arrest (August 27.09)