BRR

BRR/XBR is an ICU Var2 entry 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.

Guidelines

For any ICU patient with one of the following diagnoses:

• Cardiac Arrest Witnessed 100-2
• Cardiac Arrest Unwitnessed 100-1

code the ICU Var 2 - BRR variable as follows:

• BRR - cooling protocol was applied (BRR stands for "Brrrr" as in shivering or cold)
• XBR - no cooling protocol applied for cardiac arrest patient
• 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 however, based on the available evidence it is reasonable to consider cooling them.

• What criteria? Ttenbergen 13:55, 2012 November 7 (EST) Template:Discussion

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.

Do not collect cooling for other diagnoses

This field does not include other populations which cooling can be used for. Only cardiac arrests.

How about cooling for other reasons?

• Even though Dr. Garland's opinion in past email was that would be nice to be tag cooling protocol applied for all reasons, this is a request for addition to data collection which must be brought forth to Steering Committee for approval. Currently BRR is only being used for a very specific project related to cardiac arrests. Keep in mind that it is very easy to keep adding things to list of collected items. Unless there is someone requesting to do a specific project related cooling for other reasons and they will actually be doing something with the data, then we won't just add it because it is a good idea. ...Trish Ostryzniuk 18:08, 2012 June 18 (CDT)
  • Should this be pursued or summarized down into a "this is how it is" rather than a "should it change"?Ttenbergen 14:03, 2012 November 7 (EST)Template:Discussion

Should this be an ongoing collection?

"...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.

• • June 19.12 - Email sent to QI Team (Olafson & Easton), Critical Care Directors HSC (Paunavic, Tweed, Garland)as to above.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 and let us know the status of this. Continue collecting until we hear back.Trish Ostryzniuk 14:22, 2012 June 22 (CDT)
      • any news on that? Ttenbergen 00:43, 2012 November 2 (EDT)Template:Discussion

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)

Template:Cleaner.mdb Data Integrity Checks

• see Check BRR/XBR vs cardiac arrest dx

Legacy info only below here

Start Dates and other historical information

• 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