Initiation of Cooling by EMS to Promote Adoption of In-hospital Hypothermia in Cardiac Arrest Survivors

• Success of in-hospital cooling [ Time Frame: within 6 hours of emergency department arrival ] [ Designated as safety issue: No ]
  The primary outcome is the proportion of included patients that are successfully cooled to reach target temperature of 32 to 34 degrees Celsius within 6 hours of emergency department arrival.
  
  

• Mortality at hospital discharge [ Time Frame: Hospital discharge ] [ Designated as safety issue: No ]
  Proportion of deaths at hospital discharge
  
  
• Mortality during transport [ Time Frame: During transport to hospital ] [ Designated as safety issue: Yes ]
  Proportion of patients that die after randomization and during transport to hospital.
  
  
• Mortality during 6 hours [ Time Frame: Within 6 hours of emergency department arrival ] [ Designated as safety issue: Yes ]
  Proportion of patients that die within 6 hours of emergency department arrival
  
  
• Cooling ever in hospital [ Time Frame: within 24 hours of emergency department arrival ] [ Designated as safety issue: No ]
  Proportion of patients for whom in-hospital therapeutic hypothermia is initiated or continued within 24 hours of emergency department arrival
  
  
• Median Modified Rankin score at hospital discharge [ Time Frame: hospital discharge ] [ Designated as safety issue: No ]
  The median modified Rankin score at hospital discharge
  
  
• Good neurological outcome [ Time Frame: hospital discharge ] [ Designated as safety issue: No ]
  The proportion of patients with Modified Rankin Scale = 0, 1, or 2 at hospital discharge.
  
  
• Time of transport to hospital [ Time Frame: During transport to hospital ] [ Designated as safety issue: Yes ]
  Mean time (minutes) from arrival of paramedics on the scene to arrival and transport of patient to emergency department.
  
  

This is a large pragmatic, randomized controlled trial comparing pre-hospital initiation of therapeutic hypothermia by Emergency Medical Services (EMS) providers to conventional post-resuscitation care. The goal of this trial is to increase the proportion of cardiac arrest patients that are appropriately treated in-hospital with therapeutic hypothermia to reach the target body temperature within 6 hours of hospital arrival. The investigators believe that EMS-initiation of cooling will be a powerful reminder to in-hospital clinicians to continue therapeutic hypothermia, and will lead to care improvements across a health system. This study builds on our previous work using large hospital networks hospitals to improve the delivery of evidence-based practice.

The primary research question is as follows: Does pre-hospital initiation of therapeutic hypothermia by EMS providers increase the proportion of comatose out of hospital cardiac arrest patients with return of spontaneous circulation (ROSC) that are successfully cooled to a target temperature of 32 to 34 degrees Celsius within 6 hours of emergency department arrival, compared to usual post-resuscitation care provided in the field? The primary outcome is the proportion of included patients that are successfully cooled to reach target temperature of 32 to 34 degrees Celsius within 6 hours of emergency department arrival.