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Therapeutic Hypothermia Post–Cardiac Arrest: A Clinical Nurse Specialist Initiative in Pakistan

Manasia, Roshan Jan Muhammad MSN, RN; Husain, Shahid Javed MD; Hooda, Khairunnissa MSN, RN; Imran, Mehrunnissa BScN, RN; Bailey, Carolyn MSN, RN

doi: 10.1097/NUR.0000000000000057
Feature Article

Purpose: The purpose of this project was to assess the feasibility of an evidence-based therapeutic hypothermia protocol in adult post–cardiac arrest (CA) patients in a university hospital in Pakistan.

Background: Cardiac arrest has a deleterious effect on neurological function, and survival is associated with significant morbidity. The International Liaison Committee of Cardiopulmonary Resuscitation and the American Heart Association recommend the use of mild hypothermia in post-CA victims to mitigate brain injury caused by anoxia. In Pakistan, the survival rate in CA victims is poor. At present, there are no hospitals in the country that use the evidence-based hypothermia intervention in adult post-CA victims.

Description: This pilot project of therapeutic hypothermia in adult post-CA patients was implemented in a university hospital in Pakistan by a clinical nurse specialist in collaboration with the cardiopulmonary resuscitation committee and the nursing leadership of the hospital. Various clinical nurse specialist competencies and roles were used to address the 3 spheres of influence: patient, nurses, and system, while executing an evidence-based hypothermia protocol. Process and outcome indicators were monitored to evaluate the effectiveness and feasibility of hypothermia intervention in this setting.

Outcome: The hypothermia protocol was successfully implemented in 3 adult post-CA patients using cost-effective measures. All 3 patients were extubated within 72 hours after CA, and 2 patients were discharged home with good neurological outcome.

Conclusion: Adoption of an evidence-based hypothermia protocol for adult CA patients is feasible in the intensive care setting of a university hospital in Pakistan.

Implications: The process used in the project can serve as a road map to other hospitals in resource-limited countries such as Pakistan that are motivated to improve post-CA outcomes. This experience reveals that advanced practice nurses can be instrumental in translation of evidence into practice in a healthcare system in Pakistan.

Author Affiliations: Student, Johns Hopkins School of Nursing (Ms Manasia); Associate Professor (Dr Husain); Associate Director, Critical Care and Emergency Unit (Ms Hooda), and Clinical Nurse Specialist, Critical Care Unit (Ms Imran), Aga Khan University Hospital, Karachi, Pakistan; and Clinical Nurse Specialist, Johns Hopkins Bayview Care Center, Baltimore, Maryland (Ms Bailey).

The authors report no conflicts of interest.

Correspondence: Roshan Jan Muhammad Manasia, MSN, RN, 104 E 31st St, Austin, TX 78705 (

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