• Roshan Jan Muhammad Manasia, Shahid Javed Husain, Khairunnissa Hooda, Mehrunnissa Imran, and Carolyn Bailey.
• 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).
• Clin Nurse Spec. 2014 Jul 1;28(4):231-9.

PurposeThe 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.BackgroundCardiac 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.DescriptionThis 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.OutcomeThe 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.ConclusionAdoption of an evidence-based hypothermia protocol for adult CA patients is feasible in the intensive care setting of a university hospital in Pakistan.ImplicationsThe 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.

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