Study to Actively Warm Trauma Patients (STAY WARM): a feasibility pilot evaluation

• Published in: Canadian Journal of Surgery Vol. 64; p. S45
• Main Authors: Strauss, Rachel, Kron, Amie, Callum, Jeannie, Armali, Chantal, Modi, Dimpy, Notario, Lowyl, Perez, Pablo, Tillmann, Bourke, Pannell, Dylan, Beckett, Andrew, Tien, Homer, Nathens, Avery, Da Luz, Luis
• Format: Journal Article
• Language: English
• Published: Ottawa CMA Impact, Inc 01-10-2021
• Subjects: Feasibility studies; Heat; Hypothermia; Patients
• ISSN: 0008-428X; 1488-2310

Background: Hypothermia is a well-known predictor of unfavourable outcomes in trauma. Despite efforts to implement hypothermia prevention and treatment into our institution's massive hemorrhage protocol (MHP), a large proportion of bleeding trauma patients arrive hypothermic to our intensive care units (ICUs). The Ready-Heat chemical blanket has been used in the prehospital military setting. However, little is known about its effectiveness in hospital. We sought to understand its feasibility at our institution to improve management of hypothermic MHP patients. Methods: This was a quality improvement project assessing blanket use during initial care of MHP patients through arrival to ICU. The primary outcome was the feasibility of successfully using the blankets, defined as follows: placement of the blanket on admission, blanket remaining on patient until next or final phase of care, and at least 2 temperature recordings (1 upon admission and another at the phase of care where the blanket was removed). Secondary outcomes included improvement of hypothermia and self-reported patient comfort. Results: Five MHP patients were included. The blanket was placed on all 5 patients soon after activation of the MHP. Complete temperature recordings were obtained for 4 patients (mean admission and ICU temperatures were 35.3°C ± 1.5°C and 35.4°C ± 0.9°C, respectively). Two patients had the blanket removed in the operating room before arrival to the ICU. Initial challenges identified included the following: (1) no application of standard cotton blankets underneath the Ready-Heat blanket (required for patient safety); difficulty measuring and registering temperatures as the patient transitioned from 1 care area to another (e.g., from computed tomography suite to the operating room); and keeping the blanket on the patient across the different areas of care before patient arrival at the final destination. The following measures have been implemented to address the described challenges: additional and ongoing education sessions for nurses, physicians and other relevant staff, reinforcing reminders for temperature recordings, and signage reminding staff how to appropriately apply the blanket. Conclusion: Preliminary results demonstrate that the ReadyHeat self-warming blanket appears feasible to use in the initial care of MHP patients. However, this pilot feasibility study demonstrated implementation challenges. A second phase will enrol another 5 to 10 patients with a fluid approach involving prespecified iterations of outcome assessments and modifying intervention procedures to promote proper implementation and sustainability of the Ready-Heat blanket.