In-hospital therapeutic hypothermia in cardiac arrest survivors: Growing implementation in the Czech Republic (PRE-COOL 2: Hospital Survey 2008)
Abstract
Objective: To compare the extent of therapeutic mild hypothermia (TH) usage in cardiac arrest survivors in the Czech Republic during the last years, to assess the impact of the guidelines on TH usage and to analyze the reasons of its non-use. Design: National questionnaire survey.
Setting: Emergency Medical Service, Department of Anaesthesiology and Intensive Care Medicine. Materials and methods: After completing a list of all non-surgical intensive care units (ICU) in the Czech Republic, their lead physicians were sent a structured questionnaire in December 2006 (S2006) and October 2008 (S2008).
Results: Total 39.7% and 41.5% (p = 0.617) ICUs out of a comparable number of ICUs surveyed (S2006: n = 468, S2008: n = 487) responded. We detected an increase in TH usage among the ICUs in the Czech Republic that provide post-cardiac arrest care from 50.7% in S2006 to 63.8% in S2008 (p = 0.037).
The proportion of patients treated with TH out of all admitted cardiac arrest patients was similar (S2006: 53.3 +- 33.5%, S2008: 57.3 +- 33.2%, p = 0.317). The most powerful predictor of TH implementation in an ICU was having more than ten admitted cardiac arrest patients per year (OR 11.66, 95% CI 3.9-39.5, p < 0.001).
The most frequent reason for TH non-use as identified in S2008 was lack of funds (54.9%). A maximum incremental increase of the number of ICUs using TH occurred in 2007, predominantly on the basis of the 2005 European Resuscitation Council Guidelines.
Conclusion: A significant increase of in-hospital TH implementation in cardiac arrest survivors in the Czech Republic was observed during the last years. It was especially promoted by the recent guidelines for cardiopulmonary resuscitation.