title: Variability of Post-Cardiac Arrest Care Practices Among Cardiac Arrest Centers: United States and South Korean Dual Network Survey of Emergency Physician Research Principal Investigators.
abstract: There is little consensus regarding many post-cardiac arrest care parameters. Variability in such practices could confound the results and generalizability of post-arrest care research. We sought to characterize the variability in post-cardiac arrest care practice in Korea and the United States. A 54-question survey was sent to investigators participating in one of two research groups in South Korea (Korean Hypothermia Network [KORHN]) and the United States (National Post-Arrest Research Consortium [NPARC]). Single investigators from each site were surveyed (N = 40). Participants answered questions based on local institutional protocols and practice. We calculated descriptive statistics for all variables. Forty surveys were completed during the study period with 30 having greater than 50% of questions completed (75% response rate; 24 KORHN and 6 NPARC). Most centers target either 33°C (N = 16) or vary the target based on patient characteristics (N = 13). Both bolus and continuous infusion dosing of sedation are employed. No single indication was unanimous for cardiac catheterization. Only six investigators reported having an institutional protocol for withdrawal of life-sustaining therapy (WLST). US patients with poor neurological prognosis tended to have WLST with subsequent expiration (N = 5), whereas Korean patients are transferred to a secondary care facility (N = 19). Both electroencephalography modality and duration vary between institutions. Serum biomarkers are commonly employed by Korean, but not US centers. We found significant variability in post-cardiac arrest care practices among US and Korean medical centers. These practice variations must be taken into account in future studies of post-arrest care.
authors.affiliation: 1 Department of Emergency Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.|2 Department of Physician Assistant Studies, University of the Sciences , Philadelphia, Pennsylvania.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Coppler
authors.affiliation: 3 Department of Emergency Medicine, William Beaumont Hospital , Royal Oak, Michigan.
authors.forename: Kelly N
authors.initials: KN
authors.lastname: Sawyer
authors.affiliation: 4 Department of Emergency Medicine, The Catholic University of Korea , Seoul, South Korea .
authors.forename: Chun Song
authors.initials: CS
authors.lastname: Youn
authors.affiliation: 4 Department of Emergency Medicine, The Catholic University of Korea , Seoul, South Korea .
authors.forename: Seung Pill
authors.initials: SP
authors.lastname: Choi
authors.affiliation: 4 Department of Emergency Medicine, The Catholic University of Korea , Seoul, South Korea .
authors.forename: Kyu Nam
authors.initials: KN
authors.lastname: Park
authors.affiliation: 4 Department of Emergency Medicine, The Catholic University of Korea , Seoul, South Korea .
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Kim
authors.affiliation: 5 Department of Emergency Medicine, Michigan State University College of Human Medicine , Grand Rapids, Michigan.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Reynolds
authors.affiliation: 6 Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University Hospital , Philadelphia, Pennsylvania.
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
authors.affiliation: 7 Chonnam National University Hospital , Gwangju, South Korea .
authors.forename: Byung Kook
authors.initials: BK
authors.lastname: Lee
authors.affiliation: 4 Department of Emergency Medicine, The Catholic University of Korea , Seoul, South Korea .
authors.forename: Joo Suk
authors.initials: JS
authors.lastname: Oh
authors.affiliation: 8 Ulsan University College of Medicine , Asan Medical Center, Seoul, South Korea .
authors.forename: Won Young
authors.initials: WY
authors.lastname: Kim
authors.affiliation: 9 Soonchunhyang University Cheonan Hospital , Cheonan, South Korea .
authors.forename: Hyung Jun
authors.initials: HJ
authors.lastname: Moon
authors.affiliation: 10 Department of Emergency Medicine, Pereleman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.affiliation: 1 Department of Emergency Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.|11 Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Elmer
authors.affiliation: 1 Department of Emergency Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.affiliation: 1 Department of Emergency Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Rittenberger
mesh_terms: D001833:Body Temperature Regulation; D006328:Cardiac Catheterization / Q000639:trends; D019033:Delivery of Health Care, Integrated / Q000639:trends*; D004569:Electroencephalography / Q000639:trends; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000639:trends*; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007036:Hypothermia, Induced / Q000639:trends*; D007263:Infusions, Parenteral; D010818:Practice Patterns, Physicians' / Q000639:trends*; D056910:Republic of Korea; D016896:Treatment Outcome; D014481:United States; D028761:Withholding Treatment / Q000639:trends
chemical_list: D006993:Hypnotics and Sedatives
keywords: cardiac arrest; critical care neuroprognostication; targeted temperature management; therapeutic hypothermia; withdrawal of life-sustaining therapies