title: Use of therapeutic hypothermia after in-hospital cardiac arrest.
abstract: OBJECTIVE
  Formal guidelines recommend that therapeutic hypothermia be considered after in-hospital cardiac arrest. The rate of therapeutic hypothermia use after in-hospital cardiac arrest and details about its implementation are unknown. We aimed to determine the use of therapeutic hypothermia for adult in-hospital cardiac arrest, whether use has increased over time, and to identify factors associated with its use.
  
  
  METHODS
  Multicenter, prospective cohort study.
  
  
  METHODS
  A total of 538 hospitals participating in the Get With the Guidelines-Resuscitation database (2003-2009).
  
  
  METHODS
  A total of 67,498 patients who had return of spontaneous circulation after in-hospital cardiac arrest.
  
  
  METHODS
  None.
  
  
  RESULTS
  The primary outcome was the initiation of therapeutic hypothermia. We measured the proportion of therapeutic hypothermia patients who achieved target temperature (32-34 °C) and were overcooled. Of 67,498 patients, therapeutic hypothermia was initiated in 1,367 patients (2.0%). The target temperature (32-34 °C) was not achieved in 44.3% of therapeutic hypothermia patients within 24 hours and 17.6% were overcooled. The use of therapeutic hypothermia increased from 0.7% in 2003 to 3.3% in 2009 (p < 0.001). We found that younger age (p < 0.001) and occurrence in a non-ICU location (p < 0.001), on a weekday (p = 0.005), and in a teaching hospital (p = 0.001) were associated with an increased likelihood of therapeutic hypothermia being initiated.
  
  
  CONCLUSIONS
  After in-hospital cardiac arrest, therapeutic hypothermia was used rarely. Once initiated, the target temperature was commonly not achieved. The frequency of use increased over time but remained low. Factors associated with therapeutic hypothermia use included patient age, time and location of occurrence, and type of hospital.
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA. mark.mikkelsen@uphs.upenn.edu
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.forename: Meeta Prasad
authors.initials: MP
authors.lastname: Kerlin
authors.forename: Barry D
authors.initials: BD
authors.lastname: Fuchs
authors.forename: William D
authors.initials: WD
authors.lastname: Schweickert
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Vincent N
authors.initials: VN
authors.lastname: Mosesso
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D004059:Diffusion of Innovation; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data / Q000639:trends; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012111:Residence Characteristics / Q000706:statistics & numerical data; D013696:Temperature; D013997:Time Factors