title: A knowledge translation collaborative to improve the use of therapeutic hypothermia in post-cardiac arrest patients: protocol for a stepped wedge randomized trial.
abstract: BACKGROUND
  Advances in resuscitation science have dramatically improved survival rates following cardiac arrest. However, about 60% of adults that regain spontaneous circulation die before leaving the hospital. Recently it has been shown that inducing hypothermia in cardiac arrest survivors immediately following their arrival in hospital can dramatically improve both overall survival and neurological outcomes. Despite the strong evidence for its efficacy and the apparent simplicity of this intervention, recent surveys show that therapeutic hypothermia is delivered inconsistently, incompletely, and often with delay.
  
  
  METHODS
  This study will evaluate a multi-faceted knowledge translation strategy designed to increase the utilization rate of induced hypothermia in survivors of cardiac arrest across a network of 37 hospitals in Southwestern Ontario, Canada. The study is designed as a stepped wedge randomized trial lasting two years. Individual hospitals will be randomly assigned to four different wedges that will receive the active knowledge translation strategy according to a sequential rollout over a number of time periods. By the end of the study, all hospitals will have received the intervention. The primary aim is to measure the effectiveness of a multifaceted knowledge translation plan involving education, reminders, and audit-feedback for improving the use of induced hypothermia in survivors of cardiac arrest presenting to the emergency department. The primary outcome is the proportion of eligible OHCA patients that are cooled to a body temperature of 32 to 34°C within six hours of arrival in the hospital. Secondary outcomes will include process of care measures and clinical outcomes.
  
  
  CONCLUSIONS
  Inducing hypothermia in cardiac arrest survivors immediately following their arrival to hospital has been shown to dramatically improve both overall survival and neurological outcomes. However, this lifesaving treatment is frequently not applied in practice. If this trial is positive, our results will have broad implications by showing that a knowledge translation strategy shared across a collaborative network of hospitals can increase the number of patients that receive this lifesaving intervention in a timely manner.
  
  
  BACKGROUND
  ClinicalTrials.gov Trial Identifier: NCT00683683.
authors.affiliation: RESCU Research Program, Keenan Research Centre, Li Ka Shing Knowledge Institute, St, Michael's Hospital Toronto, Canada. morrisonl@smh.ca.
authors.forename: Katie N
authors.initials: KN
authors.lastname: Dainty
authors.forename: Damon C
authors.initials: DC
authors.lastname: Scales
authors.forename: Steve C
authors.initials: SC
authors.lastname: Brooks
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.forename: Niall
authors.initials: N
authors.lastname: Ferguson
authors.forename: Gordon
authors.initials: G
authors.lastname: Rubenfeld
authors.forename: Randy
authors.initials: R
authors.lastname: Wax
authors.forename: Merrick
authors.initials: M
authors.lastname: Zwarenstein
authors.forename: Kevin
authors.initials: K
authors.lastname: Thorpe
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012042:Registries; D012107:Research Design; D012189:Retrospective Studies; D015996:Survival Rate; D057170:Translational Research, Biomedical; D016896:Treatment Outcome