Therapeutic hypothermia after cardiac arrest: a survey of practice in intensive care units in the United Kingdom

Abstract

Summary A telephone survey was carried out on the use of hypothermia as part of the management of unconscious patients following cardiac arrest admitted to United Kingdom (UK) intensive care units (ICUs). All 256 UK ICUs listed in the Critical Care Services Manual 2004 were contacted to determine how many units have implemented therapeutic hypothermia for unconscious patients admitted following cardiac arrest, how it is implemented, and the reasons for non‐implementation. Two hundred and forty‐six (98.4%) ICUs agreed to participate. Sixty‐seven (28.4%) ICUs have cooled patients after cardiac arrest, although the majority of these have treated fewer than 10 patients. The commonest reasons given for not using therapeutic hypothermia in this situation are logistical or resource issues, or the perceived lack of evidence or consensus within individual ICU teams.

Post–Cardiac Arrest Syndrome

“…A survey of all ICUs in the United Kingdom showed that by 2006, only 27% of units had ever used mild hypothermia to treat post-cardiac arrest patients. 365 Similar findings were reported in surveys in the United States 366,367 and Germany. 368 Successful implementation has been described by several centers, however.…”

Outcome following admission to UK intensive care units after cardiac arrest: a secondary analysis of the ICNARC Case Mix Programme Database*

“…We were unable to discriminate those patients with deliberately induced hypothermia from those with unintentional hypothermia, making it difficult to interpret these data. However, a recent telephone survey of UK practice indicates that very few of these patients would have been treated with induced hypothermia [38].…”

The precision of PiCCO®measurements in hypothermic post‐cardiac arrest patients

“…Therapeutic hypothermia has been shown to improve neurological outcome after cardiac arrest in two randomised clinical trials [9,10]. Consequently, reducing body temperature to 32 -34°C with subsequent rewarming after 24-48 h has become a standard procedure following cardiac arrest [1,3,[11][12][13]. Therefore, haemodynamic and pulmonary variables need to be evaluated in these patients under both normothermic and hypothermic conditions.…”