open access

Vol 75, No 7 (2017)
Original articles
Published online: 2017-04-11
Submitted: 2016-12-03
Accepted: 2017-03-21
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Implementation of targeted temperature management after cardiac arrest in Polish intensive care units. What has changed in the last five years?

Paweł Krawczyk, Anna Tarczyńska, Grzegorz Dziadek, Miłosz Gołębiowski, Andrzej A. Kononowicz, Janusz Andres
DOI: 10.5603/KP.a2017.0073
·
Kardiol Pol 2017;75(7):689-697.

open access

Vol 75, No 7 (2017)
Original articles
Published online: 2017-04-11
Submitted: 2016-12-03
Accepted: 2017-03-21

Abstract

Background: Studies conducted up to 2010 indicate the underuse of targeted temperature management (TTM) in Poland.

Aim: This study evaluated the current degree of TTM implementation in Polish intensive care units (ICUs) and analysed the implementation process since 2010.

Methods: A telephone survey, conducted from December 2014 to July 2015, was carried out to determine the number of ICUs using TTM in patients after cardiac arrest. We collected data on the details and prevalence of TTM, and the impact of organisational and financial issues and recently published papers on its use.

Results: We obtained data from 271 of 396 ICUs (68.4%). In total, 79 (29.2%) ICUs indicated TTM use and 27 (34.2%) used dedicated TTM equipment. Overall, 62% of the ICUs used TTM regardless of the cardiac arrest rhythm. Target temperatures of 32–34°C and 34.1–36°C were reached by 44.3% and 43.0% of ICUs, respectively. The duration of TTM was 12–24 h in 58.2% of the ICUs. The most common barriers to TTM implementation were a lack of dedicated devices (36.3%) and organ­isational and logistical issues (31.2%). Any influence of recently published data on TTM practice modifications was reported by only 23.4% of the ICUs.

Conclusions: Targeted temperature management is underused in Polish ICUs. There is a need for additional educational and implementation efforts supporting the translation of knowledge into clinical practice at the regional and national levels.

Abstract

Background: Studies conducted up to 2010 indicate the underuse of targeted temperature management (TTM) in Poland.

Aim: This study evaluated the current degree of TTM implementation in Polish intensive care units (ICUs) and analysed the implementation process since 2010.

Methods: A telephone survey, conducted from December 2014 to July 2015, was carried out to determine the number of ICUs using TTM in patients after cardiac arrest. We collected data on the details and prevalence of TTM, and the impact of organisational and financial issues and recently published papers on its use.

Results: We obtained data from 271 of 396 ICUs (68.4%). In total, 79 (29.2%) ICUs indicated TTM use and 27 (34.2%) used dedicated TTM equipment. Overall, 62% of the ICUs used TTM regardless of the cardiac arrest rhythm. Target temperatures of 32–34°C and 34.1–36°C were reached by 44.3% and 43.0% of ICUs, respectively. The duration of TTM was 12–24 h in 58.2% of the ICUs. The most common barriers to TTM implementation were a lack of dedicated devices (36.3%) and organ­isational and logistical issues (31.2%). Any influence of recently published data on TTM practice modifications was reported by only 23.4% of the ICUs.

Conclusions: Targeted temperature management is underused in Polish ICUs. There is a need for additional educational and implementation efforts supporting the translation of knowledge into clinical practice at the regional and national levels.

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Keywords

survey, therapeutic hypothermia, targeted temperature management, cooling, post-cardiac arrest care, cardiac arrest, guidelines implementation

About this article
Title

Implementation of targeted temperature management after cardiac arrest in Polish intensive care units. What has changed in the last five years?

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 75, No 7 (2017)

Pages

689-697

Published online

2017-04-11

DOI

10.5603/KP.a2017.0073

Bibliographic record

Kardiol Pol 2017;75(7):689-697.

Keywords

survey
therapeutic hypothermia
targeted temperature management
cooling
post-cardiac arrest care
cardiac arrest
guidelines implementation

Authors

Paweł Krawczyk
Anna Tarczyńska
Grzegorz Dziadek
Miłosz Gołębiowski
Andrzej A. Kononowicz
Janusz Andres

References (30)
  1. Böttiger BW, Van Aken HK. Saving 100,000 lives each year in Europe. Best Pract Res Clin Anaesthesiol. 2013; 27(3): 291–292.
  2. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002; 346(8): 549–556.
  3. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; 346(8): 557–563.
  4. Nolan JP, Morley PT, Hoek TL, et al. Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison committee on Resuscitation. Resuscitation. 2003; 57(3): 231–235.
  5. Nolan JP, Deakin CD, Soar J, et al. European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation. 2005; 67 Suppl 1: S39–S86.
  6. Deakin CD, Nolan JP, Soar J, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation. 2010; 81(10): 1305–1352.
  7. Monsieurs KG, Nolan JP, Bossaert LL, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015; 95: 1–80.
  8. Wolfrum S, Radke PW, Pischon T, et al. Mild therapeutic hypothermia after cardiac arrest - a nationwide survey on the implementation of the ILCOR guidelines in German intensive care units. Resuscitation. 2007; 72(2): 207–213.
  9. Bianchin A, Pellizzato N, Martano L, et al. Therapeutic hypothermia in Italian intensive care units: a national survey. Minerva Anestesiol. 2009; 75(6): 357–362.
  10. Laver SR, Padkin A, Atalla A, et al. Therapeutic hypothermia after cardiac arrest: a survey of practice in intensive care units in the United Kingdom. Anaesthesia. 2006; 61(9): 873–877.
  11. Krawczyk P, Fraczek B, Drab E. Use of therapeutic hypothermia in Polish intensive care units. Resuscitation. 2008; 79(2): 339.
  12. Krawczyk P, Kołodziej G, Szpyra B, et al. Implementation of therapeutic hypothermia after cardiac arrest in intensive care units in Poland. Kardiol Pol. 2013; 71(3): 270–274.
  13. Polish registry of operators executing medical activity. . https://rpwdl.csioz.gov.pl (Accessed 24 November 2015).
  14. R Core Team (2016). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/ (Accessed 21 August 2016).
  15. Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013; 369(23): 2197–2206.
  16. Kim F, Nichol G, Maynard C, et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest. JAMA. 2014; 311(1): 45–52.
  17. Gasparetto N, Scarpa D, Rossi S, et al. Therapeutic hypothermia in Italian Intensive Care Units after 2010 resuscitation guidelines: still a lot to do. Resuscitation. 2014; 85(3): 376–380.
  18. Greif R, Lockey AS, Conaghan P, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 10. Education and implementation of resuscitation. Resuscitation. 2015; 95: 288–301.
  19. Widimsky P, Wijns W, Fajadet J, et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J. 2010; 31(8): 943–957.
  20. Zeliaś A, Stępińska J, Andres J, et al. Ten-year experience of an invasive cardiology centre with out-of-hospital cardiac arrest patients admitted for urgent coronary angiography. Kardiol Pol. 2014; 72(8): 687–699.
  21. Storm C, Meyer T, Schroeder T, et al. Use of target temperature management after cardiac arrest in Germany--a nationwide survey including 951 intensive care units. Resuscitation. 2014; 85(8): 1012–1017.
  22. Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council. European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care. Intensive Care Med. 2015; 41(12): 2039–2056.
  23. Deye N, Cariou A, Girardie P, et al. Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest: A Randomized, Controlled Study. Circulation. 2015; 132(3): 182–193.
  24. Hessel EA. Therapeutic hypothermia after in-hospital cardiac arrest: a critique. J Cardiothorac Vasc Anesth. 2014; 28(3): 789–799.
  25. Arrich J, Holzer M, Havel C, et al. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Syst Rev. 2016; 2: CD004128.
  26. Schenone AL, Cohen A, Patarroyo G, et al. Therapeutic hypothermia after cardiac arrest: A systematic review/meta-analysis exploring the impact of expanded criteria and targeted temperature. Resuscitation. 2016; 108: 102–110.
  27. Targeted temperature management after cardiac arrest. N Engl J Med. 2014; 370(14): 1356–1361.
  28. Deye N, Vincent F, Michel P, et al. SRLF Trial Group. Changes in cardiac arrest patients' temperature management after the 2013 "TTM" trial: results from an international survey. Ann Intensive Care. 2016; 6(1): 4.
  29. Castrén M, Nordberg P, Svensson L, et al. Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Circulation. 2010; 122(7): 729–736.
  30. Nie C, Dong J, Zhang P, et al. Prehospital therapeutic hypothermia after out-of-hospital cardiac arrest: a systematic review and meta-analysis. Am J Emerg Med. 2016; 34(11): 2209–2216.

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