SAN ANTONIO – A month-long quality improvement project to increase the use of forced-air warming blankets reduced mean hypothermia times in trauma patients at Parkland Memorial Hospital, Dallas, from 229 to 154 minutes.
All it took to get doctors, nurses, and staff to use the forced-air warming blankets more often was a reminder that hypothermia is an independent predictor of death in trauma, and data showing that Parkland, a Level 1 trauma center, used forced-air warming in just 11% of its hypothermic trauma patients. Meetings to get those points across were held in December 2014.
Forced-air warming jumped to 70% of hypothermic patients over the next 4 months in 2015 (P equal to or less than .0001), leading to the 33% drop in rewarming times (P = .009). The improvement came without any shift in the use of the rewarming methods trauma teams were in the habit of using: warm blankets, room air, and IV fluids.
Investigator Dr. Frank Zhao thinks it’s something all trauma centers can and should do. “There’s no reason that we shouldn’t recommend this be part of the rewarming protocol in every trauma center. It took about a month to roll this out so everyone was on the same page and was easily achieved,” said Dr. Zhao, formerly a Parkland surgery resident but now a trauma and surgical critical care fellow at the Oregon Health and Sciences University in Portland.
The blankets are an almost universal presence in operating rooms to keep core temperatures at least 36 degrees Celsius, but “from what I’ve seen at multiple institutions, the Bair Hugger is probably one of the least used warming methods” in trauma. “They’re recommended for trauma rewarming, but we [didn’t] use them very often.” Staff were not in the habit, he said at the Eastern Association for the Surgery of Trauma scientific assembly.
From July to November 2014, before the intervention, 15.2% (114) of Levels 1 and 2 trauma patients arrived at Parkland hypothermic, versus 20.9% (82) during the colder period of January-April 2015. Almost 80% of the trauma patients over that time were male, and the average patient age was about 40 years.
The investigators have no disclosures, and there was no outside funding for the project.