Date of Award

2011

Document Type

Thesis

Degree Name

Master of Science in Nursing (MSN)

First Advisor

Mary Alice Hodge

Abstract

Cardiac arrests are responsible for about 325,000 deaths annually in the United States (Heart Rhythm Foundation, 2010). The majority of these cardiac arrests occur outside the hospital setting, with a dismal national survival rate of 8% (American Heart Association, 2010). The Bernard (2002) and HACA (2002) studies demonstrated that by initiating therapeutic hypothermia as a treatment modality for cardiac arrests the survival rate could be as high as 49% and 55% respectively. Therapeutic hypothermia can be initiated in many different settings. The question remains, does the setting of the initiation of therapeutic hypothermia effect patient outcomes? The purpose of this study was to compare the effects of initiation of therapeutic hypothermia by EMS, Emergency Departments, and ICU nurses on cardiac arrest patient outcomes as measured by the Glasgow Coma Scale at discharge.

This study utilized a convenience sample of 178 consecutive cardiac arrest patients admitted from 2008-2010 in an 800-bed hospital in Western North Carolina. From the overall sample, 57 patients had a favorable neurological outcome (32% overall survival rate). EMS initiated therapeutic hypothermia in 24 instances with 7 patients surviving to discharge (29% survival rate). The Emergency Department initiated therapeutic hypothermia in 17 instances with 8 patients surviving to discharge (47% survival rate).

ICU nurses initiated therapeutic hypothermia in 137 instances with 42 patients surviving to discharge (31% survival rate). Study results reproduced previous findings demonstrating the efficacy of therapeutic hypothermia in the treatment of cardiac arrests. The results also indicate a possible advantage to the initiation of therapeutic hypothermia by Emergency Departments.

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