Abstract P91: Mild Therapeutic Hypothermia After Cardic Arrest, a Nationwide Survey on the Implementation of the ILCOR Guidelines in Intensive Care Units
Background: The use of mild therapeutic hypothermia (MTH) is recommended by the ILCOR in patients after cardiac arrest. Previous surveys in Europe as well as in the United States revealed that MTH is markedly underused.
Methods: All German hospitals registered for providing ICUs (n=772) were contacted via email using a structured evaluation questionnaire between 2008 and 2009.
Results: 56% of all centers contacted completed the survey. As compared to the results of our previous survey the use of MTH significantly increased from 24% in 2005 to 69% in 2009 (p<0.05). In 2009, 307 ICUs reported to treat patients with MTH after cardiac arrest and estimated that a total of 11148 patients underwent such therapy between 2002 and 2009 in Germany. In 59% of the patients cardiac arrest was due to myocardial infarction, where 6% received thrombolytic therapy and 73% underwent acute percutaneous coronary Intervention (PCI). Out of the 138 ICUs not using MTH, 60% regard MTH as too expensive. However, the majority of centers which already have implemented MTH uses economically priced cold packs (75%) and cold infusions (86%) for cooling whereas a minority uses specific equipment such as cooling mattresses (29%) or intravascular cooling devices (25%). Regarding the target temperature (mean 33°C), duration of cooling (mean 23 h) and velocity of re-warming (mean 0.3°C/h) the ICUs follow the current guidelines. 78%, 69%, and 67% of the ICU consider hypotension, infections, and bleeding as a consequence of hypothermia which is of therapeutic relevance in only 12%, 27%, and 29% of the cases, respectively. The majority of ICUs consider MTH as a safe (92%), potent with respect to mortality and neurological outcome (73%), and cost efficient (65%) therapy in patients after cardiac arrest.
Conclusions: Despite a significant increase over the last 4 years, there is still a significant number of ICUs not using MTH after cardiac arrest, mainly for economic reasons, although MTH can be easily performed using low-cost strategies. Therefore, efforts need to be intensified to promote this therapeutic option and hypothermia should be included into future advanced cardiovascular life support protocols.