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)
  • I think 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 however based on the available evidence it is reasonable to consider cooling them.
    • I believe, the rationale for the code XBR is to identify those patients who meet all our criteria for coding so that we can examine how often patients who meet all criteria to initiate cooling but are not cooled.-Dr. KendissOlafson. Sept 15.10

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 – “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)