PURPOSE: Few studies on the efficacy of mild therapeutic hypothermia (MTH) after in-hospital cardiac arrest (IHCA) occurring outside the operating room have been published to date. Although no benefits have been demonstrated, current guidelines suggest the possibility of benefit after in-hospital cardiac arrest (IHCA). We assessed the current extent of MTH use in IHCA patients, the methods for induction, and the reasons for non-use in a nationwide survey of pulmonary, critical care, and cardiology physicians.
METHODS: : An Internet based survey was distributed electronically to a random sample of 2021 e-mails taken from the member directory of three professional societies; the American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the American College of Cardiology (ACC). Participants were asked about their experience, selection criteria, and methods in using MTH after IHCA, as well as the reasons for non-use in this patient population. Demographic data included hospital type and specialty.
RESULTS: A total of 2021 physicians were surveyed. 14% responded, with 58% from teaching hospitals and 77% trained in Pulmonary and/or Critical Care medicine. 67% of respondents reported having cooled IHCA patients, with the majority (64%) having cooled <20 patients. The most-common commercial method used was a cold-water vest, used by 50% of hospitals with IHCA MTH protocols. The most common exclusion criteria used were the presence of active bleeding (70%), metastatic cancer (60%), and dementia (45%). The most common reason for not having induced MTH after IHCA was the lack of a hypothermia protocol (47%) in their institution.
CONCLUSION: 67% of U.S critical care and cardiology physicians reported inducing MTH in patients after IHCA, with the majority having cooled less than 20 patients. The most common reason for not cooling was the persistent lack of a hypothermia protocol at their hospital.
CLINICAL IMPLICATIONS: The majority of U.S critical care physicians are inducing MTH in selected patients after IHCA despite lack of evidence of benefit. This highlights the need for studies assessing the benefits of MTH after IHCA.
DISCLOSURE: Lisa Szainwald, No Financial Disclosure Information; No Product/Research Disclosure Information