BRR

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Program:	CC
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BRR/XBR is an entry we use to identify whether patients are receiving therapeutic hypothermia (Targeted Temperature Management or 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.

Guidelines / Collection Instructions

For any ICU patient with one of the following diagnoses:

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

code in TMP follows:

• Project: Cooling
• item
  • BRR (BRR stands for "Brrrr" as in shivering or cold)
    • cooling protocol was applied >= 12 hrs (unless patient died before)
    • cooled for >= 12 hrs prior to arrival to your ICU
  • XBR - no cooling protocol applied, or applied for < 12hrs
  • Do not code BRR or XBR when a cooling protocol is used to normalize temperature for any type of non-cardiac arrest patients.

how important is the 12 hr part?

how important is the 12 hr part? We will no longer care about the 12 hours, and it will not be part of the ICD10 definition. Code if started, regardless of stopping. Put cooling onto the list. only use cooling code for post-arrest

• SMW

• Cargo

• Categories

We want to capture all patients who are cooled post cardiac arrest whether they meet criteria for Cardiac Arrest Cooling Protocol or not. A significant portion of patients following cardiac arrest do not meet all the criteria listed, however, based on the available evidence it is reasonable to consider cooling them. Template:Discussion

• I wonder how important it is to exclude the patients that are cooled less than 12 hours? Sometimes the patient is only in the unit a shorter time after arrest and they may die or it is difficult to tell exactly when the TTM ended. Would it not be better to include all TTM patients instead of excluding those that are less than 12 hours on the protocol? --LKolesar 10:12, 2017 November 28 (CST)
  • I agree with Laura. At the Concordia the charting is so poor it is very hard to tell if the cooling occured for 12 hours or not.Could we ask about this in task? GHall 11:40, 2018 January 22 (CST)
    • I have emailed Allan about this and put it on the list for Task meeting. Ttenbergen 12:26, 2018 February 8 (CST)
• Allan's answer: I think we should code CCI Procedure 1.ZZ.06 Hypothermy if they start on it at all (i.e. eliminate timeline). As indicated, the charting may be inadequate to let us know how long it was done --- and one reason it may be done only briefly is that the patient died.
  • The purpose of this field is to show whether the cardiac cooling protocol was followed. Its criteria was to cool 12-24 hrs. We used to list the whole protocol in this article and pruned it down to the 12 hr definition because it's collectable. See e.g. this old version]. If Critical Care or Cardiology still want to use this data to show if the protocol is being followed we would need this threshold, no? Ttenbergen 16:12, 2018 February 12 (CST)

Template:CCMDB Data Integrity Checks

see Check BRR/XBR vs cardiac arrest dx

CCI

Template:CCITemplate:Discussion If I understand right this will be coded as CCI Procedure 1.ZZ.06 Hypothermy. We will need to

• import old tmp entries accordingly
• change cross checks to the new encoding method.
• how do we ensure that all cardiac arrest patients either have TTM (targeted temperature management)or not if you use CCI? The correct term should be TTM. Hypothermia is not always needed. The idea is to keep the patient's temperature from going high. Usual maintenance temp is 36 degrees.

Background

Start Dates

• 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
• moved from ICU Var 2 into TMP on Dec 18, 2014

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.