Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-25T18:52:13.743Z Has data issue: false hasContentIssue false
  • English
  • Français

The use of induced hypothermia after cardiac arrest: a survey of Canadian emergency physicians

Published online by Cambridge University Press:  21 May 2015

Joel Kennedy ,
Robert S. Green ,
Robert Stenstrom  and
on behalf of the CAEP Critical Care Committee
Joel Kennedy
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS
Robert S. Green*
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS Department of Internal Medicine, Division of Critical Care Medicine, Dalhousie University, Halifax, NS
Robert Stenstrom
Affiliation:
St. Paul's Hospital and the University of British Columbia, Vancouver, BC
*
Dalhousie University, Department of Medicine, Division of Critical Care Medicine, and the Department of Emergency Medicine, Rm. 377, Bethune Building, 1278 Tower Rd., Halifax NS B3H 2Y9; greenrs@dal.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Inducing mild hypothermia in survivors of cardiac arrest has been demonstrated to improve outcomes. Despite this, other studies have found that few resuscitation physicians have used hypothermia in clinical practice. The objective of this study was to characterize the use of induced hypothermia by Canadian emergency physicians.

Methods:

An internet-based survey was distributed to all members of the Canadian Association of Emergency Physicians (CAEP). Participants were asked about their experience with, methods for and barriers to inducing hypothermia.

Results:

Of the 1328 CAEP members surveyed, 247 (18.6%) responded, with the majority working in academic centres (60.3%). Ninety-five out of 202 respondents (47.0%, 95% confidence interval [CI] 40.8%–53.2%) indicated that they had induced hypothermia in clinical practice and 86 of 212 (40.6%, 95% CI 34.0%–47.2%) worked in a department that had a policy or protocol for the use of induced hypothermia. The presence of a departmental policy or protocol was strongly associated with the use of induced hypothermia (unadjusted odds ratio 10.5, 95% CI 5.3–20.8). Barriers against induced hypothermia cited by respondents included a lack of institutional policies and protocols (38.9%), and of resources (29.4%). Lack of support from consultants was relatively uncommon (8.7%) in Canadian practice.

Conclusion:

Only one-half of Canadian emergency physicians report that they have used therapeutic hypothermia in practice. Emergency departments should develop policies or protocols for inducing hypothermia in cardiac arrest survivors to optimize patient outcomes.

Keywords

induced hypothermiaemergency medicinecardiac arrestpolicy protocol
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 2 , March 2008 , pp. 125 - 130
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Becker, LB, Smith, DW, Rhodes, KV. Incidence of cardiac arrest: a neglected factor in evaluating survival rates. Ann Emerg Med 1993;22:86–91.CrossRefGoogle ScholarPubMed
2.Vreede-Swagemakers, JJ, Gorgels, AP, Dubois-Arbouw, WI, et al. Out-of-hospital cardiac arrest in the 1990’s: a population-based study in the maastricht area on incidence, characteristics and survival. J Am Coll Cardiol 1997;30:1500–5.CrossRefGoogle Scholar
3.Holzer, M, Bernard, SA, Hachimi-Idrissi, S, et al. Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis. Crit Care Med 2005;33:414–8.Google Scholar
4.Stiell, IG, Wells, GA, DeMaio, VJ, et al. Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS study phase I results. Ontario prehospital advanced life support. Ann Emerg Med 1999;33:44–50.CrossRefGoogle Scholar
5.Herlitz, J, Ekstrom, L, Wennerblom, B, et al. Effect of bystander initiated cardiopulmonary resuscitation on ventricular fibrillation and survival after witnessed cardiac arrest outside hospital. Br Heart J 1994;72:408–12.CrossRefGoogle ScholarPubMed
6.Cummins, RO, Ornato, JP, Thies, WH, et al. Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the advanced cardiac life support subcommittee and the emergency cardiac care committee, american heart association. Circulation 1991;83:1832–47.Google Scholar
7.Larsen, MP, Eisenberg, MS, Cummins, RO, et al. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med 1993;22:1652–8.Google Scholar
8.Bernard, SA, Gray, TW, Buist, MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002;346:557–63.CrossRefGoogle ScholarPubMed
9.HACA. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002;346:549–56.CrossRefGoogle Scholar
10.American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 7.5: postresuscitation support. Circulation 2005;112:IV–84.Google Scholar
11.Nolan, JP, Morley, PT, Vanden Hoek, TL, et al. Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the international liaison committee on resuscitation. Circulation 2003;108:118–21.Google ScholarPubMed
12.Green, RS, Howes, D. Hypothermic modulation of anoxic brain injury in adult survivors of cardiac arrest: A review of the literature and an algorithm for emergency physicians. CJEM 2005;7:42–7.Google Scholar
13.Howes, D, Green, RS, Gray, S, et al. Evidence for the use of hypothermia after cardiac arrest. CJEM 2006;8:109–15.Google Scholar
14.Canadian Association of Emergency Physicians; CAEP Critical Care Committee. Guidelines for the use of hypothermia after cardiac arrest. CJEM 2006;8:106–8.CrossRefGoogle Scholar
15.Merchant, RM, Soar, J, Skrifvars, MB, et al. Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest. Crit Care Med 2006;34:1935–40.CrossRefGoogle ScholarPubMed
16.Abella, BS, Rhee, JW, Huang, KN, et al. Induced hypothermia is underused after resuscitation from cardiac arrest: a current practice survey. Resuscitation 2005;64:181–6.CrossRefGoogle ScholarPubMed
17.Xiao, F. Bench to bedside: brain edema and cerebral resuscitation: the present and future. Acad Emerg Med 2002;9:933–46.Google Scholar
18.Vaagenes, P, Ginsberg, M, Ebmeyer, UM, et al. Cerebral resuscitation from cardiac arrest: pathophysiologic mechanisms. Crit Care Med 1996;24(Suppl):S57–68.CrossRefGoogle ScholarPubMed
19.Cheung, KW, Green, RS, Magee, KD. Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients. CJEM 2006;8:329–37.Google Scholar
20.Green, RS, Howes, DW. Stock your emergency department with ice packs: a practical guide to therapeutic hypothermia for survivors of cardiac arrest. CMAJ 2007;176:759–62.CrossRefGoogle ScholarPubMed