(1210) Multidisciplinary Brain Rescue Alert Initiative in Neurocritical Care (Multi-BRAIN) Project

Introduction: Intracranial hypertension and cerebral herniation are life threatening neurologic emergencies, encompassing the term "Brain Code" (BC) for which process for reversal are not readily available in hospitals. In addition, hyperosmolar therapy (HT) administration is usually delayed. We describe the establishment of a multidisciplinary BC process in a tertiary hospital as part of a quality improvement process.

Methods: A multidisciplinary BC taskforce comprised of pharmacists, nursing, physicians, that represent the intensive care units (ICU), neurocritical care and neurosurgery was established with the aim of creating the BC process, to decrease the time-to-first-hyperosmolar-therapy (TTFHT), and to establish the post-BC process and documentation. The proposed process created and was approved by the medical staff for the pilot phase. Education was done across ICUs. The BC kit contained two pre-mixed syringes of 23.4%, 1-500cc bag of 3%, 8-vials of mannitol 20%, and phenylephrine (100mcg/1mL) premade syringe. The BC bag contained the pupillometer, smartguard, ABG kit, filters, additional 50cc syringes, rapid-EEG box and band, documentation sheet, BC protocol and omnicell tipsheet.

Results: The Multi-BRAIN project was piloted over the course of 12 months, during which BC was activated 21 times from the NCCU, Medical ICU, CVICU and the emergency room (ER). Compared to the baseline TTFHT of more than 60 minutes, the overall mean TTFHT was 6 minutes. 81% of BC activation occurred during the day and 57% occurred outside of the NCCU. The most common HT used was a combination of 23.4% and mannitol. 52.4% of clinical herniation symptom was reversed post-BC. The most common post-BC action was stat neuroimaging. 57.1% of HT was administered through peripheral intravenous access without any complications. The Multi-BRAIN process will be utilized as a hospital process after the pilot phase.

Conclusions: We demonstrated the feasibility of creating a multidisciplinary BC for a hospital that can be utilized across all ICUs and the ER. We also demonstrated the novel contents of the BC-kit, BC-bag and RSI-kit that were successfully utilized through this process. Multidisciplinary involvement in the development of a BC process is crucial for its success.