Abstract 60: Prehospital induced hypothermia after out-of-hospital cardiac arrest: Emergency Medical Services State of the Practice in the US in 2007
Objective-Post-resuscitation care of comatose survivors of cardiac arrest using induced hypothermia (IH) is recommended by the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR). However, the current rate of its use by Emergency Medical Services (EMS) in the US is not known. We sought to determine the prevalence of EMS agencies that initiate IH in the prehospital setting, and to identify perceived barriers to initiating IH.
Methods- We conducted a prospective, anonymous, IRB-approved survey using a convenience sample of physician members of the National Association of EMS Physicians. We conducted the survey during the national conference, from January 11–13, 2007.
Results- One-hundred forty-five of the 244 (59%) physician members in attendance completed the survey, representing 109 EMS Medical Directors and 36 non-Medical Director EMS Physicians from 92 regions of 34 US states. A total of 9/145 (6.2%) physicians stated that the EMS agency they are affiliated with have protocols for IH. The median (IQR) duration of having a protocol was 12 months (6 –12) and all used either ice bags or cold IV fluid, or a combination of the two. Among those that reported prehospital use of IH, only 1/8 (12.5%) reported having cooled greater than 10% of eligible patients. Common perceived barriers to IH include: providers being overburdened with other tasks (62.1%), short transport times (60.7%), lack of refrigeration equipment (60.0%), and receiving hospitals’ failure to continue therapeutic hypothermia (56.6%). Twenty-two percent incorrectly indicated that IH was not in the AHA guidelines and only 62% correctly identified 32–34 degrees C as the recommended target temperature range.
Conclusions- Despite advisory statements from the AHA/ILCOR recommending the early implementation of post-resuscitation cooling of comatose survivors of cardiac arrest, prehospital initiation of IH in the US is rare. Infrequent use of prehospital IH seen in our sample may be due to the perceived barriers that were identified and/or incomplete understanding of guidelines by medical providers. Future studies should examine methods for overcoming barriers and improving guideline dissemination to EMS physicians.