Abstract
BackgroundTherapeutic 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.MethodsA declarative survey was performed using the webmail database of the French Intensive Care Society including 3229 physicians (from May 2014 to January 2015).ResultsFive 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).ConclusionsThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-015-0104-6) contains supplementary material, which is available to authorized users.
Highlights
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
The three main randomized trials evaluating temperature management (TTM) after CA seem to highlight that all TTM procedures (e.g., 36 °C-TTM and 33 °C-TTM) are beneficial when compared with non-TTM regimen [1, 2, 6,7,8]
This issue, reinforced by a recent meta-analysis, has been recalled by the International Liaison Committee On Resuscitation (ILCOR) experts, possibly to avoid any definitive abandon of TTM implementation after CA [9, 10]. These experts assume that the published studies do not support a treatment strategy where TTM is abandoned but support a strategy where either 33 or 36 °C-TTM remains an important component of post-CA treatment [9]
Summary
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. Intensive Care (2016) 6:4 hypothermia: TH) versus 36 °C both applied during 28 h This trial mostly included out-of-hospital CA patients with relatively short no-flow durations occurring from both initial non-shockable and shockable rhythms. The three main randomized trials evaluating TTM after CA seem to highlight that all TTM procedures (e.g., 36 °C-TTM and 33 °C-TTM) are beneficial when compared with non-TTM regimen [1, 2, 6,7,8] This issue, reinforced by a recent meta-analysis, has been recalled by the International Liaison Committee On Resuscitation (ILCOR) experts, possibly to avoid any definitive abandon of TTM implementation after CA [9, 10]. To the best of our knowledge, no study has to date evaluated the potential impact of these different TTM trials on the post-CA management
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
