Therapeutic hypothermia after out-of hospital cardiac arrest: how to secure worldwide implementation.
OBJECTIVE
Despite the scientific evidence, therapeutic hypothermia in comatose out-of-hospital cardiac arrest survivors is still not widely used. It is unlikely that technical, logistical and financial barriers alone can explain the geographically large differences in its application. Our review focuses on how generic knowledge on implementation may help speed up the transfer of therapeutic hypothermia into daily practice.


RESULTS
In countries like Finland and Norway, rapid nationwide implementation has been obtained. Surveys from larger countries like the US, UK and Germany, however, show an overall low implementation rate of therapeutic hypothermia. Recent comparisons of outcome before and after implementation of therapeutic hypothermia in unselected groups of patients (effectiveness studies) show the same benefit as that found in previous randomized controlled trials (efficacy studies). New studies show that logistical, financial, technical and safety aspects cannot be considered barriers to the implementation of therapeutic hypothermia into daily practice.


CONCLUSIONS
More than 40 years after the late Peter Safar first suggested therapeutic hypothermia as standard therapy during postresuscitation care, worldwide implementation of this treatment seems possible. To secure this, however, hospitals and health systems must institute well defined implementation plans taking local cultural and organizational barriers into account.
Søreide
Eldar
E
Department of Anaesthesia and Intensive Care, Stavanger University Hospital, Stavanger, Norway. soed@sus.no
Sunde
Kjetil
K
D019317:Evidence-Based Medicine; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D016032:Randomized Controlled Trials as Topic