Anest. intenziv. Med. 2011;22(6):320-327

To cool or not to cool? Obstacles to implementing therapeutic hypothermia guidelinesIntensive Care Medicine - Original Paper

Fiala Hynek^1,*, Berta Emil², Gabrhelík Tomáš¹, Šafránek Petr¹

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny Fakultní nemocnice Olomouc

² Dept. of Anesthesia and Intensive Care, Ringerike Hospital (Vestre Viken HF), Hønefoss, Norway

Objective:
To determine the cause of failed guideline implementation.

Design:
A questionnaire survey.


Setting:
University Hospital ICU and Emergency Department.

Methods:
The authors conducted a questionnaire survey among all healthcare workers participating in the care for patients after cardiopulmonary resuscitation in University Hospital Olomouc (total 67 medical professionals). The respondents were asked about factors preventing them from employing therapeutic hypothermia. Physician respondents were queried about the reasons for not initiating or discontinuing of cooling, inducing muscle relaxation, and the effect of analgesia and sedation on the cooling process.

Results:
All the respondents were convinced that therapeutic hypothermia was the right treatment. The physicians stated the following obstacles to delivering high-quality hypothermia: lack of time, inadequate equipment, and lack of nursing protocols and documentation. According to the nurses, the obstacles included lack of equipment, no nursing protocol, and unclear physicians' decisions. All the physicians claimed they would have initiated cooling even after prolonged resuscitation or an unwitnessed circulatory arrest without basic CPR. A general "tendency to wake up" was the reason for not initiating cooling for 23% of the respondents. For the same reason, 30% of physicians would discontinue cooling.
The most important prerequisites for successful therapeutic hypothermia, as perceived by the physicians, were the availability of the cooling device, the initial fluid bolus, and analgesia and sedation. According to the nurses, a clear physician's decision to use hypothermia and its specification, availability of the equipment and the initial fluid bolus were the most important factors.

Conclusion:
In the healthcare workers' opinion, employment of mild therapeutic hypothermia may be improved by the equipment availability, introduction of a nursing protocol and greater awareness among physicians and nurses. A cooling system with automatic temperature regulation appears to be the most important condition for successful cooling. A separate chart for therapeutic hypothermia documentation was considered unnecessary by more than a half of the respondents.

Keywords: cardiopulmonary resuscitation; therapeutic hypothermia; guidelines; post-resuscitation syndrome

Received: July 13, 2011; Accepted: November 11, 2011; Published: December 1, 2011  Show citation