ROCHESTER, Minn. — Forced body cooling known as therapeutic hypothermia has reduced in-hospital deaths among sudden cardiac arrest patients nearly 12 percent between 2001 and 2009, according to a Mayo Clinic study being presented at the upcoming American Academy of Neurology 2012 Annual Meeting in New Orleans. The research is among several Mayo abstracts that will be discussed at the conference.
The goal of therapeutic cooling is slowing the body's metabolism and preventing brain damage or death. It is believed that mild therapeutic hypothermia suppresses harmful chemical reactions in the brain and preserves cells. Two key studies published in 2002 found therapeutic hypothermia more effective for sudden cardiac arrest patients than traditional therapies. Mayo researchers analyzed a database covering more than 1 million patients and found mortality rates among in-hospital sudden cardiac arrest patients dropped from 69.6 percent in 2001 — the year before the studies appeared — to 57.8 percent in 2009, the most recent data available.
"Because we reviewed such a large number of cases, we are confident that the reduction in mortality among in-hospital sudden cardiac arrest patients is significant and sustained," says co-author Alejandro Rabinstein, M.D., a Mayo Clinic neurologist. "We continue to seek answers to the questions: Why did this trend develop, and how can we accelerate it," says co-author Jennifer Fugate, D.O.
These measures are important because disease accumulates in the cortex over time, and inflammation in the cortex is a sign the disease has progressed.
Other studies being presented at AAN include:
Structured resident sign-out during shift changes improves patient care: In the study, junior residents in Mayo Clinic's General Neurology, Stroke and Neurologic Intensive Care Units spent the first half of their rotations using unstructured sign-out approaches and transitioned to a structured system for the second half. The residents reported that the standardized sign-out improved communication substantially, including information on pertinent past medical history, pending lab tests, recommendations on how to handle nursing and pharmacy calls, and up-to-date code status. Residents using standardized sign-out were also more likely to share test results with patients and their families prior to shift changes. This led to a significant increase in overall satisfaction with the sign-out process.
"This study is particularly timely now, when residency programs are adjusting to new duty-hour restrictions established in 2010," says lead author Brian Moseley, M.D., a Mayo Clinic neurology resident and Assistant Professor of Neurology. "When you have hand-offs because of the duty restrictions, unless the communication is good, there is a lot of opportunity for error," says Jeffrey Britton, M.D., a Mayo Clinic neurologist and study co-author. "This structured method seems to both prevent the error, but also make the patient and their family feel comfortable that this important communication is happening," says Dr. Britton.