Abstract Body: Throughout the world, neurologically intact survival to discharge remains low. The Joint Commission (TJC) released post resuscitation requirements in January of 2022. Sanford Bemidji reviewed options that would meet the TJC requirements: Transfer the patient or develop a novel way to meet those needs in the current setting. With the latter, the positive impact on patients is significant in that they receive a high care level of care close to home without delay in care.
Sanford Bemidji Medical Center is a rural regional 118-bed hospital in Minnesota with a 14-bed Intensive Care unit. We are unique in that despite our size we serve a large regional footprint of over 100,000 people including three Native American reservations. Our objective was to utilize evidence based guidelines to implement a post cardiac arrest care (PCAC) workflow for adult cardiac arrest patients who obtain return of spontaneous circulation (ROSC) by end of first quarter 2023. The project incorporated low cost equipment and staff training. We used the Plan, Do, Study, Act cycle for our methodology. The outcome metric was neurologically intact survival to hospital discharge. Process metrics included placement and use of the ROSC order set, fever avoidance, rapid EEG completed, MAP over 65, and oxygen saturations of 92-98%. Sixty-one adult patients (both in hospital and out of hospital) suffered cardiac arrest at Sanford Bemidji in the 9 months following project implementation in 2023. Demographics included 3 native americans and 2 caucasians, ages 57-73, 3 males and 2 females. Our overall survival rate remained above the national average. For the few patients who met criteria for ROSC interventions, 4 of 5 (80%) received the ROSC interventions, 2 of 4 (50%) survived hospital to discharge neurologically intact. Results showed an increase in maintaining optimal MAP from 81% in 2022 to 100% in 2023 and achieving oxygen saturation parameters 80% of the time in 2023 compared to 66% in 2022. Real time monitoring and coaching of the order set is needed to increase utilization of the order set in full (fever avoidance was at 20% and rapid EEG completed in 40% of cases with a goal of 100% for both).
More data is needed to ascertain the outcomes of a ROSC workflow in like sized hospitals with similar resources. The novelty of this innovative project is in the implementation of an evidence based PCAC workflow in a 118-bed rural hospital giving all cardiac arrest patients a chance for a full recovery.