title: Changes in cardiac arrest patients' temperature management after the 2013 "TTM" trial: results from an international survey.
abstract: BACKGROUND
  Therapeutic hypothermia (TH between 32 and 34 °C) was recommended until recently in unconscious successfully resuscitated cardiac arrest (CA) patients, especially after initial shockable rhythm. A randomized controlled trial published in 2013 observed similar outcome between a 36 °C-targeted temperature management (TTM) and a 33 °C-TTM. The main aim of our study was to assess the impact of this publication on physicians regarding their TTM practical changes.
  
  
  METHODS
  A declarative survey was performed using the webmail database of the French Intensive Care Society including 3229 physicians (from May 2014 to January 2015).
  
  
  RESULTS
  Five hundred and eighteen respondents from 264 ICUs in 11 countries fulfilled the survey (16 %). A specific attention was generally paid by 94 % of respondents to TTM (hyperthermia avoidance, normothermia, or TH implementation) in CA patients, whereas 6 % did not. TH between 32 and 34 °C was declared as generally maintained during 12-24 h by 78 % of respondents or during 24-48 h by 19 %. Since the TTM trial publication, 56 % of respondents declared no modification of their TTM practice, whereas 37 % declared a practical target temperature change. The new temperature targets were 35-36 °C for 23 % of respondents, and 36 °C for 14 %. The duration of overall TTM (including TH and/or normothermia) was declared as applied between 12 and 24 h in 40 %, and between 24 and 48 h in 36 %. In univariate analysis, the physicians' TTM modification seemed related to hospital category (university versus non-university hospitals, P = 0.045), to TTM-specific attention paid in CA patients (P = 0.008), to TH durations (<12 versus 24-48 h, P = 0.01), and to new targets temperature (32-34 versus 35-36 °C, P < 0.0001).
  
  
  CONCLUSIONS
  The TTM trial publication has induced a modification of current practices in one-third of respondents, whereas the 32-34 °C target temperature remained unchanged for 56 %. Educational actions are needed to promote knowledge translations of trial results into clinical practice. New international guidelines may contribute to this effort.
authors.affiliation: Réanimation Médicale et Toxicologique, Unité Inserm U942, Centre Hospitalier Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, 2, rue Ambroise Paré, 75010, Paris, France. nicolas.deye@lrb.aphp.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Deye
authors.affiliation: Réanimation Polyvalente, Groupe Hospitalier Inter-Communal Le Raincy-Montfermeil, Montfermeil, France.
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.affiliation: Réanimation Polyvalente, Centre Hospitalier Régional René Dubost, Pontoise, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Michel
authors.affiliation: Réanimation Polyvalente, Centre Hospitalier Régional Universitaire, Tours, France.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ehrmann
authors.affiliation: Réanimation, Centre Hospitalier Delafontaine, Saint-Denis, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: da Silva
authors.affiliation: Department of Intensive Care Experimental Medicine Laboratory, Centre Hospitalier Universitaire, Charleroi, Belgium.
authors.forename: Michael
authors.initials: M
authors.lastname: Piagnerelli
authors.affiliation: Réanimation Médicale, Centre Hospitalier Universitaire de Nancy Brabois, Vandoeuvre-les-Nancy, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Kimmoun
authors.affiliation: Réanimation Polyvalente, Hôpital Antoine Béclère, APHP, Clamart, France.
authors.forename: Olfa
authors.initials: O
authors.lastname: Hamzaoui
authors.affiliation: Réanimation Polyvalente, Centre Hospitalier Départemental Les Oudairies, La Roche-Sur-Yon, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Lacherade
authors.affiliation: Réanimation Médicale, Centre Hospitalier Inter-Communal, Poissy, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: de Jonghe
authors.affiliation: Réanimation Polyvalente, Centre Hospitalier Régional René Dubost, Pontoise, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Brouard
authors.affiliation: Clinique des Cèdres-Cornebarrieu, Blagnac, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Audoin
authors.affiliation: Réanimation Médicale, Centre Hospitalier Universitaire Paris-Sud, APHP, Kremlin-Bicêtre, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Monnet
authors.affiliation: Medical-surgical intensive care unit, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Laterre
keywords: Cooling; Heart arrest; Survey; Targeted temperature management; Temperature; Therapeutic hypothermia