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Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest*

Merchant, Raina M. MD; Soar, Jasmeet MD; Skrifvars, Markus B. MD, PhD; Silfvast, Tom MD, PhD; Edelson, Dana P. MD; Ahmad, Fawaz BA; Huang, Kuang-Ning; Khan, Monica; Vanden Hoek, Terry L. MD; Becker, Lance B. MD; Abella, Benjamin S. MD, MPhil

doi: 10.1097/01.CCM.0000220494.90290.92
Clinical Investigations

Objective: We sought to evaluate current physician use of therapeutic hypothermia after cardiac arrest, to ascertain reasons for nonadoption of this treatment, and to determine current cooling techniques employed.

Design: Web-based survey.

Setting: International physician cohort in the United States, UK, and Finland.

Subjects: Physicians (MD or DO) caring for resuscitated cardiac arrest patients.

Interventions: An anonymous Web-based survey was distributed to physicians identified through United States–based critical care, cardiology, and emergency medicine directories and critical care networks in the UK and Finland. Recipients were queried regarding use of postresuscitation therapeutic hypothermia.

Measurements and Main Results: Of the final 13,272 surveys actually distributed to physicians, 2,248 (17%) were completed. Most respondents were attending physicians (82%) at teaching hospitals (76%) who practiced critical care (35%), cardiology (20%), or emergency medicine (22%). Of all replies, 74% of United States respondents and 64% of non–United States respondents had never used therapeutic hypothermia. United States emergency medicine physician adoption of cooling was significantly less than that of United States intensivists (16% vs. 34%, p < .05). The most often cited reasons for nonuse by respondents were “not enough data,” “not part of Advanced Cardiac Life Support guidelines,” and “too technically difficult to use.” Factors associated with increased use included non–United States residence, critical care specialty, and larger hospital size.

Conclusions: Physician utilization of cooling after cardiac arrest remains low. For improved adoption of therapeutic hypothermia, our data suggest that development of better cooling methodology and recent incorporation into resuscitation guidelines may improve use.

From the Section of Emergency Medicine, University of Chicago, Chicago, IL (RMM, DPE, FA, KNH, MK, TLVH, LBB, BSA); Section of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK (JS); and the Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland (MBS, TS).

Financial support provided by an internal grant from the University of Chicago Emergency Resuscitation Center, Chicago, IL.

Dr. Becker has received research support from the National Institutes of Health (NIH), Philips Medical Systems (Seattle, WA), Laerdal Medical (Stavanger, Norway), and Alsius Corporation (Irvine, CA) and is a consultant for Abbot Labs (Abbot Park, IL) and Philips Medical Systems (Seattle, WA). Dr. Vanden Hoek has received research support from the National Institutes of Health and Department of Defense, Office of Naval Research; and Dr. Abella has received research support from the National Institutes of Health, Philips Medical Systems (Seattle, WA), and Laerdal Medical (Stavanger, Norway) and has received honoraria from Alsius Corporation (Irvine, CA). The remaining authors have no financial interests to disclose.

Research was conducted at University of Chicago Hospitals, Southmead Hospital, and Helsinki University Hospital.

Address requests for reprints to: Benjamin S. Abella, MD, University of Chicago Hospitals, 5841 S. Maryland Ave., Rm MC5068, Chicago, IL 60637. E-mail: BABELLA@MEDICINE.BSD.UCHICAGO.EDU

© 2006 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins