title: Therapeutic hypothermia in Italian Intensive Care Units after 2010 resuscitation guidelines: still a lot to do.
abstract: BACKGROUND
  Therapeutic hypothermia (TH) is one of three interventions that have demonstrated to improve patients' neurological outcome after cardiac arrest. The aim of this study was to investigate the effect of the 2010 resuscitation guidelines on TH implementation in various Italian Intensive Care Units (ICU).
  
  
  METHODS
  A structured questionnaire was submitted to Italian ICU. The questionnaire was addressed to determine the procedures of TH in each ICU or, on the contrary, the reason for not employing the therapy.
  
  
  RESULTS
  We obtained complete information from 770 of 847 Italian ICU (91%). Out of 405 Units included in the analysis only 223 (55.1%) reported to use TH in comatose patients after return of spontaneous circulation. The trend of TH implementation shows a stable increase, particularly after 2006 but there is no evident acceleration after the strong indication of the 2010 guidelines. There was a rise of about 3.4 times in the number of Italian ICU using TH as compared to the 2007 survey (an increase of 68% per year). One hundred and eighty-two (44.9%) units did not use TH mainly because of lack of equipment, economic issues or the conviction of the difficulty of execution.
  
  
  CONCLUSIONS
  TH is still under-used in Italy (55.1%) even though the therapy is strongly recommended in the 2010 guidelines. However, the increase in the adoption of hypothermia has been significant in the past 5 years (68%/years) and the awareness of the efficacy is almost consolidated among intensivists, being logistic problems the leading cause for non-adoption.
authors.affiliation: Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, via Giustiniani 2, 35128 Padua, Italy. Electronic address: gasparetto.nicola@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gasparetto
authors.affiliation: Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, via Giustiniani 2, 35128 Padua, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Scarpa
authors.affiliation: Anaesthesia and Intensive Care Institute, Department of Medicine, University Hospital of Padua, via Cesare Battisti 267, 35128 Padua, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rossi
authors.affiliation: Anaesthesia and Intensive Care Institute, Department of Medicine, University Hospital of Padua, via Cesare Battisti 267, 35128 Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Persona
authors.affiliation: Emergency Department, University Hospital of Padua, via Giustiniani 2, 35128 Padua, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Martano
authors.affiliation: Anaesthesia and Intensive Care Unit, S. Valentino Hospital, via Togliatti 1, 31044 Montebelluna, Treviso, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bianchin
authors.affiliation: Intensive Care Unit, ASL TO 4, S. Giovanni Bosco Hospital, Piazza Donatore di Sangue 3, 10154 Turin, Italy.
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Castioni
authors.affiliation: Anaesthesia and Intensive Care Institute, Department of Medicine, University Hospital of Padua, via Cesare Battisti 267, 35128 Padua, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
authors.affiliation: Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, via Giustiniani 2, 35128 Padua, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, via Giustiniani 2, 35128 Padua, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Cacciavillani
mesh_terms: D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000592:standards*; D007362:Intensive Care Units; D007558:Italy; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: Cardiac arrest; Guidelines; Hypothermia; Intensive Care Unit; Resuscitation; Survey