The current temperature: A survey of post-resuscitation care across Australian and New Zealand intensive care units

Abstract

AimTargeted temperature management (TTM) in post-resuscitation care has changed dramatically over the last two decades. However, uptake across Australian and New Zealand (NZ) intensive care units (ICUs) is unclear. We aimed to describe post-resuscitation care in our region, with a focus on TTM, and to gain insights into clinician’s opinions about the level of evidence supporting TTM. MethodsIn December 2017, we sent an online survey to 163 ICU medical directors in Australia (n ​= ​141) and NZ (n ​= ​22). ResultsSixty-one ICU medical directors responded (50 from Australia and 11 from NZ). Two respondents were excluded from analysis as their Private ICUs did not admit post-arrest patients. The majority of remaining respondents stated their ICU followed a post-resuscitation care clinical guideline (n ​= ​41/59, 70%). TTM was used in 57 (of 59, 97%) ICUs, of these only 64% had a specific TTM clinical guideline/policy and there was variation in the types of patients treated, temperatures targeted (range ​= ​33–37.5 ​°C), methods for cooling and duration of cooling (range ​= ​12–72 ​h). The majority of respondents stated that their ICU (n ​= ​45/57, 88%) changed TTM practice following the TTM trial: with 28% targeting temperatures >36 ​°C, and 23 (of 46, 50%) respondents expressed concerns with current level of evidence for TTM. Only 38% of post-resuscitation guidelines included prognostication procedures, few ICUs reported the use of electrophysiological tests. ConclusionsIn Australian and New Zealand ICUs there is widespread variation in post-resuscitation care, including TTM practice and prognostication. There also seems to be concerns with current TTM evidence and recommendations.