Mild therapeutic hypothermia after cardiac arrest - a nationwide survey on the implementation of the ILCOR guidelines in German intensive care units.
OBJECTIVE
To investigate the implementation of mild therapeutic hypothermia (MTH) after cardiac arrest into clinical practice.


RESULTS
A structured evaluation questionnaire was sent to all German hospitals registered to have ICUs; 58% completed the survey. A total of 93 ICUs (24%) reported to use MTH. Of those, 93% started MTH in patients after out-of-hospital resuscitation with observed ventricular fibrillation and 72% when other initial rhythms were observed. Only a minority of ICUs initiate MTH in patients after cardiac arrest with cardiogenic shock (28%), whereas 48% regarded cardiogenic shock as a contra-indication for MTH. On average, target temperature was 33.1+/-0.6 degrees C and duration of cooling 22.9+/-4.9 h. Many centres used economically priced cold packs (82%) and cold infusions (80%) for cooling. The majority of the ICUs considered infection, hypotension and bleeding as relevant complications of hypothermia which was of therapeutic relevance in less than 25% of the cases.


CONCLUSIONS
MTH is underused in German ICUs. Centres which use MTH widely follow the recommendations of ILCOR with respect to the indication and timing of cooling. In hospitals that use MTH the technique is considered to be safe and inexpensive. More efforts are needed to promote this therapeutic option and hypothermia since MTH has now been included into European advanced cardiovascular life support protocols.
Wolfrum
Sebastian
S
Medical Clinic II, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. Sebastian.Wolfrum@uk-sh.de
Radke
Peter W
PW
Pischon
Tobias
T
Willich
Stefan N
SN
Schunkert
Heribert
H
Kurowski
Volkhard
V
D016887:Cardiopulmonary Resuscitation / Q000379:methods; D005858:Germany; D019538:Health Care Surveys; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D006979:Hyperthermia, Induced / Q000706:statistics & numerical data*; D007362:Intensive Care Units; D017410:Practice Guidelines as Topic