Implementation of therapeutic hypothermia after cardiac arrest in intensive care units in Poland

Abstract

Therapeutic hypothermia (TH) is one of few interventions that improve survival after a cardiac arrest with good neurological outcome. Current guidelines for cardiopulmonary resuscitation recommend TH in comatose adult patients after return of spontaneous circulation (ROSC) regardless of cardiac arrest location and cardiac rhythm during the event. To evaluate level of TH implementation in intensive care units (ICUs) in Poland and identify barriers to the implementation process. A telephone survey was carried out to determine how many Polish ICUs were using TH in the management of comatose patients after a cardiac arrest. The survey was conducted from October to December 2010. The survey also included questions on the number of patients cooled, method of TH induction and maintenance, target temperature, duration of cooling, and cardiac arrest rhythm in patients treated with TH. We have also collected data on pre-hospital use of TH and potential barriers to implementation of TH. We obtained information from 263 of 464 ICUs (56.8%) in Poland. At the time of the survey, 57 ICUs (21.7%) were using TH in comatose patients after ROSC. There was a significant increase in the number of ICUs using TH as compared with the 2005 survey. Most ICUs did not use any sophisticated equipment to induce and maintain TH. Ninety six percent of ICUs were using TH regardless of the cardiac arrest rhythm. In 65% of ICUs (37 units), target temperature was 32-34°C and 63% of ICUs (36 units) maintained TH for 12-24 hours. An increase in ICU experience in TH can be noted: 61% of ICUs (35 units) declared TH use in more than 10 patients during the last year. We found the following barriers to implementation of TH: lack of knowledge, lack of local protocols, lack of equipment, and economic issues. The number of ICUs using TH in Poland increased threefold in the 5 year period of 2005-2010. However, the proportion of ICUs using TH is still low (21.7%) compared to other European countries. Further efforts should be undertaken to reduce barriers to implementation of current resuscitation guidelines.