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Hay RE, Martin DA, Rutas GJ, Jamal SM, Parsons SJ. Measuring evidence-based clinical guideline compliance in the paediatric intensive care unit. BMJ Open Qual 2024; 13:e002485. [PMID: 38429064 PMCID: PMC10910644 DOI: 10.1136/bmjoq-2023-002485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 02/13/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Evidence-based clinical care guidelines improve medical treatment by reducing error, improving outcomes and possibly lowering healthcare costs. While some data exist on individual guideline compliance, no data exist on overall compliance to multiple nuanced guidelines in a paediatric intensive care setting. METHODS Guideline compliance was observed and measured with a prospective cohort at a tertiary academic paediatric medical-surgical intensive care unit. Adherence to 19 evidence-based clinical care guidelines was evaluated in 814 patients, and reasons for non-compliance were noted along with other associated outcomes. MEASUREMENTS AND MAIN RESULTS Overall facility compliance was unexpectedly high at 77.8% over 4512 compliance events, involving 826 admissions. Compliance varied widely between guidelines. Guidelines with the highest compliance were stress ulcer prophylaxis (97.1%) and transfusion administration such as fresh frozen plasma (97.4%) and platelets (94.8%); guidelines with the lowest compliance were ventilator-associated pneumonia prevention (28.7%) and vitamin K administration (34.8%). There was no significant change in compliance over time with observation. Guidelines with binary decision branch points or single-page decision flow diagrams had a higher average compliance of 90.6%. Poor compliance was more often observed with poor perception of guideline trustworthiness and time limitations. CONCLUSIONS Measuring guideline compliance, though onerous, allowed for evaluation of current clinical practices and identified actionable areas for institutional improvement.
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Affiliation(s)
- Rebecca E Hay
- Pediatric Critical Care, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
- Pediatric Critical Care, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Dori-Ann Martin
- Pediatric Critical Care, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Gary J Rutas
- Pediatric Critical Care, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Shelina M Jamal
- Pediatric Critical Care, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Simon J Parsons
- Pediatric Critical Care, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
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Jorge-Perez P, Nikolaou N, Donadello K, Khoury A, Behringer W, Hassager C, Boettiger B, Sionis A, Nolan J, Combes A, Quinn T, Price S, Grand J. Management of comatose survivors of out-of-hospital cardiac arrest in Europe: current treatment practice and adherence to guidelines. A joint survey by the Association for Acute CardioVascular Care (ACVC) of the ESC, the European Resuscitation Council (ERC), the European Society for Emergency Medicine (EUSEM), and the European Society of Intensive Care Medicine (ESICM). EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:96-105. [PMID: 36454812 DOI: 10.1093/ehjacc/zuac153] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/15/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022]
Abstract
AIMS International guidelines give recommendations for the management of comatose out-of-hospital cardiac arrest (OHCA) survivors. We aimed to investigate adherence to guidelines and disparities in the treatment of OHCA in hospitals in Europe. METHODS AND RESULTS A web-based, multi-institutional, multinational survey in Europe was conducted using an electronic platform with a predefined questionnaire developed by experts in post-resuscitation care. The survey was disseminated to all members of the societies via email, social media, websites, and newsletters in June 2021. Of 252 answers received, 237 responses from different units were included and 166 (70%) were from cardiac arrest centres. First-line vasopressor used was noradrenaline in 195 (83%) and the first-line inotrope was dobutamine in 148 (64%) of the responses. Echocardiography is available 24/7 in 204 (87%) institutions. Targeted temperature management was used in 160 (75%) institutions for adult comatose survivors of OHCA with an initial shockable rhythm. Invasive or external cooling methods with feedback were used in 72 cardiac arrest centres (44%) and 17 (24%) non-cardiac arrest centres (P < 0.0003). A target temperature between 32 and 34°C was preferred by 46 centres (21%); a target between 34 and 36°C by 103 centres (52%); and <37.5°C by 35 (16%). Multimodal neuroprognostication was poorly implemented and a follow-up at 3 months after discharge was done in 71 (30%) institutions. CONCLUSION Post-resuscitation care is not well established and varies among centres in European hospitals. Cardiac arrest centres have a higher coherence with guidelines compared with respondents from non-cardiac arrest centres. The overall inconsistency in approaches and deviation from recommendations could be a focus for improvement.
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Affiliation(s)
- Pablo Jorge-Perez
- Department of Cardiology, Canary Islands University Hospital, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - Nikolaos Nikolaou
- Intensive Cardiac Care Unit, Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Katia Donadello
- Department of Anesthesia and Intensive Care B, Department of Surgery, Dentistry, Gynaecology and Paediatrics, University of Verona, AOUI-University Hospital Integrated Trust of Verona, Policlinico G.B. Rossi, P.le L. Scuro, Verone, Italy
| | - Abdo Khoury
- Department of Emergency Medicine and Critical Care, Besançon University Hospital, Besançon, France.,INSERM CIC 1431, Besançon University Hospital, Besançon, France
| | - Wilhelm Behringer
- Department of Emergency Medicine, Medical University Vienna, Vienna, Austria
| | - Christian Hassager
- Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, The Heart Center, Copenhagen, Denmark
| | - Bernd Boettiger
- Medical Faculty and University Hospital, University of Cologne, Cologne, Germany.,European Resuscitation Council (ERC), Niel, Belgium.,German Resuscitation Council (GRC), Ulm, Germany
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Jerry Nolan
- Warwick Medical School, University of Warwick, Coventry, UK.,Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Alain Combes
- Sorbonne Université INSERM Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Tom Quinn
- Kingston University and St. Georges, University of London, London, UK
| | - Susanna Price
- Departments of Cardiology and Critical Care, Royal Brompton & Harefield Hospitals, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Johannes Grand
- Department of Cardiology, Amager-Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
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Đuzel A, Pavlov M, Babić Z. Importance of acute cardiac care registries at the national level. Acta Clin Croat 2020; 59:233-241. [PMID: 33456110 PMCID: PMC7808236 DOI: 10.20471/acc.2020.59.02.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 12/24/2019] [Indexed: 12/04/2022] Open
Abstract
Improving organization and patient care quality in intensive care units is increasingly important as intensive care unit diagnostic and therapeutic procedures account for a growing proportion of hospital services. We identified the lack of comprehensive national and international registries available in the contemporary literature. This paper aims to describe and analyze cardiac intensive care unit (CICU) network at the national level in Croatia and its comparison with more developed countries. Thirty-four representatives from all Croatian acute hospitals (response rate of 100%) filled in a web based questionnaire on CICU organization and competence during September and October 2016. Organization and available technical procedures for health care in general, and especially in very expensive CICU treatment, highly depends on gross domestic product (GDP) per capita. That is why one could expect that Croatia, with the second lowest GDP among European Union countries and 4.7 CICU per million inhabitants will have worse results in this field in comparison with most of these countries. Results such as one nurse responsible for a mean of 2.7 CICU patients, 52% of cardiologists among physicians during working hours but 37% during night shifts, 24/7 transesophageal echocardiography in only 26.5% of CICUs, one-third without therapeutic hypothermia, and 23.5% without extracorporeal membrane oxygenation treatment are some of these results, revealing much room for improvement. This representative, nationwide sample of Croatian CICUs also demonstrated considerable variation of key elements of structures with respect to hospital size, academic status and financial issues, as well as a trend towards current guidelines. This kind of investigation is very important for proposing standards, reimbursement master plan, or quality assessment of the national health system.
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Affiliation(s)
- Ana Đuzel
- Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Marin Pavlov
- Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Zdravko Babić
- Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Kim S, Ahn KO, Ro YS, Shin SD. Factors Associated with the Transfer Decision in Resuscitated Patients with Out-of-Hospital Cardiac Arrest Presenting to a Hospital with Limited Targeted Temperature Management Capability in Korea. Ther Hypothermia Temp Manag 2019; 9:224-230. [DOI: 10.1089/ther.2018.0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sola Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Ki Ok Ahn
- Department of Emergency Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang-si, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
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5
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Đuzel A, Pavlov M, Babić Z. Cardiac intensive care unit organisation in an economically less developed European country. Intensive Care Med 2017; 44:380-381. [PMID: 29189875 DOI: 10.1007/s00134-017-5008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Ana Đuzel
- University Hospital Center "Sestre Milosrdnice", Vinogradska Street 29, Zagreb, Croatia.
| | - Marin Pavlov
- University Hospital Center "Sestre Milosrdnice", Vinogradska Street 29, Zagreb, Croatia
| | - Zdravko Babić
- University Hospital Center "Sestre Milosrdnice", Vinogradska Street 29, Zagreb, Croatia
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Du L, Ge B, Ma Q, Yang J, Chen F, Mi Y, Zhu H, Wang C, Li Y, Zhang H, Yang R, Guan J, Zhang Y, Jin G, Zhu H, Xiong Y, Wang G, Zhu Z, Zhang H, Zhang Y, Zhu J, Li J, Lan C, Xiong H. Changes in cardiac arrest patients' temperature management after the publication of 2015 AHA guidelines for resuscitation in China. Sci Rep 2017; 7:16087. [PMID: 29167495 PMCID: PMC5700174 DOI: 10.1038/s41598-017-16044-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/06/2017] [Indexed: 01/15/2023] Open
Abstract
A survey was performed to assess the current management of targeted temperature management (TTM) in patients following cardiac arrest (CA) and whether healthcare providers will change target temperature after publication of 2015 American Heart Association guidelines for resuscitation in China. 52 hospitals were selected from whole of China between August to November 2016. All healthcare providers in EMs and/or ICUs of selected hospitals participated in the study. 1952 respondents fulfilled the survey (86.8%). TTM in CA patients was declared by 14.5% of physicians and 6.7% of the nurses. Only 4 of 64 departments, 7.8% of physicians and 5.7% of the nurses had implemented TH for CA patients. Since the publication of 2015 AHA guidelines, 33.6% of respondents declared no modification of target temperature, whereas 51.5% declared a target temperature's change in future practice. Respondents were more likely to choose 35∼36 °C-TTM (54.7%) after guidelines publication, as compared to that before guidelines publication they preferred 32∼34 °C-TTM (54.0%). TTM for CA patients was still in the early stage in China. Publication of 2015 resuscitation guidelines did have impact on choice of target temperature among healthcare providers. They preferred 35∼36 °C-TTM after guidelines publication.
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Affiliation(s)
- Lanfang Du
- Department of Emergency Medicine, The Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Baolan Ge
- Department of Emergency Medicine, The Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Qingbian Ma
- Department of Emergency Medicine, The Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China.
| | - Jianzhong Yang
- Department of Emergency Medicine, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan South Rd., Wulumiqi, Xinjiang, 830054, China
| | - Fengying Chen
- Department of Emergency Medicine, The Affiliated Hospital of Innor Mongolia Medical University, No. 1, Tongdao North Rd., Huhehaote, Innor Mongolia, 010050, China
| | - Yuhong Mi
- Department of Emergency Medicine, Beijing Anzhen Hospital, 2 Anzhen Rd., Chaoyang District, Beijing, 100029, China
| | - Huadong Zhu
- Department of Emergency Medicine, Peking Union Medical College Hospital, No. 1, Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Cong Wang
- Department of Emergency Medicine, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Xicheng District, Beijing, 100035, China
| | - Yan Li
- Department of Emergency Medicine, The Second Affiliated Hospital of Shanxi Medical University, No. 382, Wuyi Rd., Taiyuan, Shanxi, 030001, China
| | - Hongbo Zhang
- Department of Emergency Medicine, China Japan friendship hospital, No. 2, Yinghua East Rd., Chaoyang District, Beijing, 100029, China
| | - Rongjia Yang
- Department of Emergency Medicine, Gansu Provincial Hospital, No. 204, Donggang West Rd., Lanzhou, Gansu, 730000, China
| | - Jian Guan
- Department of Emergency Medicine, The First Hospital of Tsinghua University, No. 6, Jiuxianqiao Yijiefang, Chaoyang District, Beijing, 100016, China
| | - Yixiong Zhang
- Department of Emergency Medicine, Hunan Provincial People's Hospital, No. 61, Jiefang West Rd., Changsha, Hunan, 410005, China
| | - Guiyun Jin
- Department of Emergency Medicine, The Affiliated Hospital of Hainan Medical University, No. 31, Longhua Rd., Haikou, Hainan, 570102, China
| | - Haiyan Zhu
- Department of Emergency Medicine, The General Hospital of People's Liberation Army, No. 28, Fuxing Rd., Beijing, 100853, China
| | - Yan Xiong
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan Second Rd., Guangzhou, Guangdong, 510080, China
| | - Guoxing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, No. 95, Yongan Rd., Xicheng District, 100050, China
| | - Zhengzhong Zhu
- Department of Emergency Medicine, Beijing University Shougang Hospital, No. 9, Jinyuanzhuang Rd., Shijingshan District, Beijing, 100144, China
| | - Haiyan Zhang
- Department of Emergency Medicine, The Hospital of Shunyi District Beijing, No. 3, Guangming South Street, Shunyi District, Beijing, 101300, China
| | - Yun Zhang
- Department of Emergency Medicine, Beijing Tongren Hospital, No. 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Jihong Zhu
- Department of Emergency Medicine, Peking University People's Hospital, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Jie Li
- Department of Emergency Medicine, Beijing Fuxing Hospital, No. 20, Fuxingmenwai Street, Xicheng District, Beijing, 100038, China
| | - Chao Lan
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Rd., Zhengzhou, Henan, 450052, China
| | - Hui Xiong
- Department of Emergency Medicine, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing, 100034, China
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Tommasi E, Lazzeri C, Bernardo P, Sori A, Chiostri M, Gensini GF, Valente S. Cooling techniques in mild hypothermia after cardiac arrest. J Cardiovasc Med (Hagerstown) 2017; 18:459-466. [DOI: 10.2459/jcm.0000000000000130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Storm C, Nee J, Sunde K, Holzer M, Hubner P, Taccone FS, Friberg H, Lopez-de-Sa E, Cariou A, Schefold JC, Ristagno G, Noc M, Donker DW, Andres J, Krawczyk P, Skrifvars MB, Penketh J, Krannich A, Fries M. A survey on general and temperature management of post cardiac arrest patients in large teaching and university hospitals in 14 European countries-The SPAME trial results. Resuscitation 2017; 116:84-90. [PMID: 28377294 DOI: 10.1016/j.resuscitation.2017.03.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/22/2017] [Accepted: 03/30/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION International guidelines recommend a bundle of care, including targeted temperature management (TTM), in post cardiac arrest survivors. Aside from a few small surveys in different European countries, adherence to the European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) recommendations are unknown. METHODS This international European telephone survey was conducted to provide an overview of current clinical practice of post cardiac arrest management with a main focus on TTM. We targeted large teaching and university hospitals within Europe as leading facilities and key opinion leaders in the field of post cardiac arrest care. Selected national principal investigators conducted the survey, which was based on a predefined questionnaire, between December 2014 and March 2015, before the publication of the ERC Guidelines 2015. RESULTS The return rate was 94% from 268 participating intensive care units (ICU). The majority had a predefined standard operating procedure (SOP) protocol for post cardiac arrest patients. Altogether, 68% of the ICUs provided TTM at a target temperature of 32-34°C for 24h, and 33% had changed the target temperature to 36°C. The minority provided a written SOP for neurological prognostication, which was generally initiated 72h after return of spontaneous circulation (ROSC). Electroencephalography and somatosensory evoked potentials were used by most ICUs for early prognostication. Treating more than fifty patients a year was significantly associated with providing written SOPs for TTM and prognostication (p<0.01), as well as the use of a computer feedback device (p=0.03) for TTM. CONCLUSION This international European telephone survey revealed a high rate of implementation of TTM in post cardiac arrest patients in university and teaching hospitals. Most participants also provided a SOP, but only a minority had a SOP for neurological prognostication.
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Affiliation(s)
| | - J Nee
- Charité-Universitätsmedizin Berlin, Germany.
| | - Kjetil Sunde
- Dept. of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | - Fabio Silvio Taccone
- Dept. of Intensive Care, Erasme Hospital-Université Libre de Bruxelles (ULB) Brussels, Belgium.
| | - Hans Friberg
- Dept. of Anesthesiology and Intensive Care Medicine, Skåne University Hospital, Lund University, Lund, Sweden.
| | | | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital (Assistance Publique Hôpitaux de Paris)-INSERM U970 (Team 4) and Paris Descartes University, France.
| | - Joerg C Schefold
- Dept. of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Giuseppe Ristagno
- Dept. of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan Italy and Italian Resuscitation Council, Bologna, Italy.
| | - Marko Noc
- Centre of Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia.
| | - Dirk W Donker
- Dept. of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Janusz Andres
- Dept. of Anaesthesiology and Intensive Care, Jagiellonian University Medical College Cracow, Poland.
| | - Pawel Krawczyk
- Dept. of Anaesthesiology and Intensive Care, Jagiellonian University Medical College Cracow, Poland.
| | - Markus B Skrifvars
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, Finland.
| | - James Penketh
- Dept. of Anaesthesia and Intensive Care Medicine, Royal United Hospital Bath, UK.
| | | | - Michael Fries
- Dept. of Anaesthesiology and Intensive Care Medicine, St. Vincenz-Hospital, Limburg, Germany, Germany.
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Orban JC, Novain M, Cattet F, Plattier R, Nefzaoui M, Hyvernat H, Raguin O, Kaidomar M, Kerever S, Ichai C. Association of serum lactate with outcome after out-of-hospital cardiac arrest treated with therapeutic hypothermia. PLoS One 2017; 12:e0173239. [PMID: 28282398 PMCID: PMC5345819 DOI: 10.1371/journal.pone.0173239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/18/2017] [Indexed: 01/22/2023] Open
Abstract
Aims Lactate reflects hypoxic insult in many conditions and is considered as a prognosis factor. But, after cardiac arrest, its interest is still debated. Our study aimed to assess the prognosis value of lactate in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. Methods This retrospective observational study included out-of-hospital cardiac arrest patients treated with therapeutic hypothermia in four ICUs. Lactate levels were compared at different times during the first 24 hours according to outcome at ICU discharge and to the type of death (multiorgan or neurologic failure). Results Two hundred and seventy-two patients were included, 89 good outcome and 183 poor outcome. In the latter group, 171 patients died, from multiorgan failure in 30% and neurologic failure in 70%. Lactate levels were higher in the poor compared to the good outcome patients at admission (5.4 (3.3–9.4) vs. 2.2 (1.5–3.6) mmol/L; p<0.01), 12 hours (2.5 (1.6–4.7) vs. 1.4 (1.0–2.2) mmol/L; p<0.01) and 24 hours (1.8 (1.1–2.8) vs. 1.3 (0.9–2.1) mmol/L; p<0.01). Patients succumbing from multiorgan failure exhibited higher lactate levels compared to those dying from neurologic failure at admission (7.9 (3.9–12.0) vs. 5.2 (3.3–8.8) mmol/L; p<0.01), H12 (4.9 (2.1–8.9) vs. 2.2 (1.4–3.4) mmol/L; p<0.01) and H24 (3.3 (1.8–5.5) vs. 1.4 (1.1–2.5) mmol/L; p<0.01). Initial lactate levels showed an increasing proportion of poor outcome from the first to fourth quartile. Conclusions After out-of-hospital cardiac arrest treated with therapeutic hypothermia, lactate levels during the first 24 hours seem linked with ICU outcome. Patients dying from multiorgan failure exhibit higher initial lactate concentrations than patients succumbing from neurological failure.
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Affiliation(s)
- Jean-Christophe Orban
- Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, Nice, France
- * E-mail:
| | - Michaël Novain
- Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, Nice, France
| | - Florian Cattet
- Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, Nice, France
| | - Rémi Plattier
- Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, Nice, France
| | - Mohamed Nefzaoui
- Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, Nice, France
| | - Hervé Hyvernat
- Medical ICU, Archet Hospital, Nice University Hospital, 151 route de Saint-Antoine, Nice, France
| | - Olivier Raguin
- Intensive Care Unit, Antibes General Hospital, 107 avenue de Nice, Antibes, France
| | - Michel Kaidomar
- Intensive Care Unit, Fréjus Saint-Raphaël General Hospital, 240 avenue de Saint-Lambert, Fréjus, France
| | - Sébastien Kerever
- Departments of Anesthesiology and Critical Care, Lariboisière University Hospital, 2 rue Ambroise Paré, Paris, France
| | - Carole Ichai
- Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, Nice, France
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Constant AL, Mongardon N, Morelot Q, Pichon N, Grimaldi D, Bordenave L, Soummer A, Sauneuf B, Merceron S, Ricome S, Misset B, Bruel C, Schnell D, Boisramé-Helms J, Dubuisson E, Brunet J, Lasocki S, Cronier P, Bouhemad B, Carreira S, Begot E, Vandenbunder B, Dhonneur G, Jullien P, Resche-Rigon M, Bedos JP, Montlahuc C, Legriel S. Targeted temperature management after intraoperative cardiac arrest: a multicenter retrospective study. Intensive Care Med 2017; 43:485-495. [PMID: 28220232 DOI: 10.1007/s00134-017-4709-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 01/31/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Few outcome data are available about temperature management after intraoperative cardiac arrest (IOCA). We describe targeted temperature management (TTM) (32-34 °C) modalities, adverse events, and association with 1-year functional outcome in patients with IOCA. METHODS Patients admitted to 11 ICUs after IOCA in 2008-2013 were studied retrospectively. The main outcome measure was 1-year functional outcome. RESULTS Of the 101 patients [35 women and 66 men; median age, 62 years (interquartile range, 42-72)], 68 (67.3%) were ASA PS I to III and 57 (56.4%) had emergent surgery. First recorded rhythms were asystole in 44 (43.6%) patients, pulseless electrical activity in 36 (35.6%), and ventricular fibrillation/tachycardia in 20 (19.8%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation (ROSC) were 0 min (0-0) and 10 min (4-20), respectively. The 30 (29.7%) patients who received TTM had an increased risk of infection (P = 0.005) but not of arrhythmia, bleeding, or metabolic/electrolyte disorders. By multivariate analysis, one or more defibrillation before ROSC was positively associated with a favorable functional outcome at 1-year (OR 3.06, 95% CI 1.05-8.95, P = 0.04) and emergency surgery was negatively associated with 1-year favorable functional outcome (OR 0.36; 95% CI 0.14-0.95, P = 0.038). TTM use was not independently associated with 1-year favorable outcome (OR 0.82; 95% CI 0.27-2.46, P = 0.72). CONCLUSIONS TTM was used in less than one-third of patients after IOCA. TTM was associated with infection but not with bleeding or coronary events in this setting. TTM did not independently predict 1-year favorable functional outcome after IOCA in this study.
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Affiliation(s)
- Anne-Laure Constant
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France.,Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Nicolas Mongardon
- Department of Anesthesiology and Surgical Intensive Care Units, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.,Faculté de médecine, Université Paris Est, 8 avenue du général Sarrail, 94000, Créteil, France.,Inserm, U955, Equipe 3 "Stratégies pharmacologiques et thérapeutiques expérimentales des insuffisances cardiaques et coronaires", 8 avenue du général Sarrail, Créteil, France
| | - Quentin Morelot
- SBIM Biostatistics and Medical information, Hôpital Saint-Louis, APHP, 1, avenue Claude Vellefaux, Paris, France.,Université Paris Diderot, Paris, France.,ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Nicolas Pichon
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Universitaire de Limoges, 2, avenue Martin-Luther-King, 87042, Limoges, France
| | - David Grimaldi
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Lauriane Bordenave
- Department of Anesthesiology, Institut Gustave Roussy, 39, rue Camille-Desmoulins, 94805, Villejuif Cedex, France
| | - Alexis Soummer
- Department of Intensive Care Medicine, Foch Hospital, 40 rue Worth, 92150, Suresnes, France
| | - Bertrand Sauneuf
- Pôle Anesthésie-Réanimation-SAMU, CHU de Caen, Avenue de la côte de Nacre, CS30001, 14033, Caen Cedex 9, France
| | - Sybille Merceron
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Sylvie Ricome
- Department of Anesthesiology and Critical Care, Assistance Publique des Hôpitaux de Paris, 100 boulevard du Général-Leclerc, 92110, Clichy la Garenne, France
| | - Benoit Misset
- Medical-Surgical Intensive Care Unit, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75614, Paris Cedex, France.,Sorbonne Paris Cité-Medical School, Paris Descartes University, Paris, France
| | - Cedric Bruel
- Medical-Surgical Intensive Care Unit, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75614, Paris Cedex, France
| | - David Schnell
- Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julie Boisramé-Helms
- Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de médecine, Université de Strasbourg, Strasbourg, France
| | - Etienne Dubuisson
- Department of Anesthesiology, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Jennifer Brunet
- Pôle Anesthésie-Réanimation-SAMU, CHU de Caen, Avenue de la côte de Nacre, CS30001, 14033, Caen Cedex 9, France
| | - Sigismond Lasocki
- Pôle d'Anesthésie Réanimation, CHU d'Angers, 4 rue Larrey, 49933, Angers Cedex 9, Angers, France.,LUNAM Université, CHU d'Angers, 49933, Angers Cedex, France
| | - Pierrick Cronier
- Intensive Care Unit, Centre Hospitalier Sud-Francilien, 116 boulevard Jean Jaurès, 91106, Corbeil-Essonnes Cedex, France
| | - Belaid Bouhemad
- Department of Anesthesiology and Critical Care, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75614, Paris Cedex, France
| | - Serge Carreira
- Department of Intensive Care Medicine, Hôpital Saint-Camill, 2 rue des Pères-Camiliens, 94360, Bry-sur-Marne, France
| | - Emmanuelle Begot
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Universitaire de Limoges, 2, avenue Martin-Luther-King, 87042, Limoges, France
| | - Benoit Vandenbunder
- Department of Anesthesiology, Foch Hospital, 40 rue Worth, 92150, Suresnes, France
| | - Gilles Dhonneur
- Department of Anesthesiology and Surgical Intensive Care Units, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.,Faculté de médecine, Université Paris Est, 8 avenue du général Sarrail, 94000, Créteil, France
| | - Philippe Jullien
- Department of Anesthesiology, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Matthieu Resche-Rigon
- SBIM Biostatistics and Medical information, Hôpital Saint-Louis, APHP, 1, avenue Claude Vellefaux, Paris, France.,Université Paris Diderot, Paris, France.,ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-Pierre Bedos
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Claire Montlahuc
- SBIM Biostatistics and Medical information, Hôpital Saint-Louis, APHP, 1, avenue Claude Vellefaux, Paris, France.,Université Paris Diderot, Paris, France.,ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Stephane Legriel
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France. .,Sorbonne Paris Cité-Medical School, Paris Descartes University, Paris, France. .,INSERM U970, Paris Cardiovascular Research Center, Paris, France.
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11
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Deye N, Vincent F, Michel P, Ehrmann S, da Silva D, Piagnerelli M, Kimmoun A, Hamzaoui O, Lacherade JC, de Jonghe B, Brouard F, Audoin C, Monnet X, Laterre PF. Changes in cardiac arrest patients' temperature management after the 2013 "TTM" trial: results from an international survey. Ann Intensive Care 2016; 6:4. [PMID: 26753837 PMCID: PMC4709360 DOI: 10.1186/s13613-015-0104-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/27/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Therapeutic hypothermia (TH between 32 and 34 °C) was recommended until recently in unconscious successfully resuscitated cardiac arrest (CA) patients, especially after initial shockable rhythm. A randomized controlled trial published in 2013 observed similar outcome between a 36 °C-targeted temperature management (TTM) and a 33 °C-TTM. The main aim of our study was to assess the impact of this publication on physicians regarding their TTM practical changes. METHODS A declarative survey was performed using the webmail database of the French Intensive Care Society including 3229 physicians (from May 2014 to January 2015). RESULTS Five hundred and eighteen respondents from 264 ICUs in 11 countries fulfilled the survey (16 %). A specific attention was generally paid by 94 % of respondents to TTM (hyperthermia avoidance, normothermia, or TH implementation) in CA patients, whereas 6 % did not. TH between 32 and 34 °C was declared as generally maintained during 12-24 h by 78 % of respondents or during 24-48 h by 19 %. Since the TTM trial publication, 56 % of respondents declared no modification of their TTM practice, whereas 37 % declared a practical target temperature change. The new temperature targets were 35-36 °C for 23 % of respondents, and 36 °C for 14 %. The duration of overall TTM (including TH and/or normothermia) was declared as applied between 12 and 24 h in 40 %, and between 24 and 48 h in 36 %. In univariate analysis, the physicians' TTM modification seemed related to hospital category (university versus non-university hospitals, P = 0.045), to TTM-specific attention paid in CA patients (P = 0.008), to TH durations (<12 versus 24-48 h, P = 0.01), and to new targets temperature (32-34 versus 35-36 °C, P < 0.0001). CONCLUSIONS The TTM trial publication has induced a modification of current practices in one-third of respondents, whereas the 32-34 °C target temperature remained unchanged for 56 %. Educational actions are needed to promote knowledge translations of trial results into clinical practice. New international guidelines may contribute to this effort.
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Affiliation(s)
- Nicolas Deye
- />Réanimation Médicale et Toxicologique, Unité Inserm U942, Centre Hospitalier Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, 2, rue Ambroise Paré, 75010 Paris, France
| | - François Vincent
- />Réanimation Polyvalente, Groupe Hospitalier Inter-Communal Le Raincy-Montfermeil, Montfermeil, France
| | - Philippe Michel
- />Réanimation Polyvalente, Centre Hospitalier Régional René Dubost, Pontoise, France
| | - Stephan Ehrmann
- />Réanimation Polyvalente, Centre Hospitalier Régional Universitaire, Tours, France
| | - Daniel da Silva
- />Réanimation, Centre Hospitalier Delafontaine, Saint-Denis, France
| | - Michael Piagnerelli
- />Department of Intensive Care Experimental Medicine Laboratory, Centre Hospitalier Universitaire, Charleroi, Belgium
| | - Antoine Kimmoun
- />Réanimation Médicale, Centre Hospitalier Universitaire de Nancy Brabois, Vandoeuvre-les-Nancy, France
| | - Olfa Hamzaoui
- />Réanimation Polyvalente, Hôpital Antoine Béclère, APHP, Clamart, France
| | - Jean-Claude Lacherade
- />Réanimation Polyvalente, Centre Hospitalier Départemental Les Oudairies, La Roche-Sur-Yon, France
| | - Bernard de Jonghe
- />Réanimation Médicale, Centre Hospitalier Inter-Communal, Poissy, France
| | - Florence Brouard
- />Réanimation Polyvalente, Centre Hospitalier Régional René Dubost, Pontoise, France
| | | | - Xavier Monnet
- />Réanimation Médicale, Centre Hospitalier Universitaire Paris-Sud, APHP, Kremlin-Bicêtre, France
| | - Pierre-François Laterre
- />Medical-surgical intensive care unit, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - For the SRLF Trial Group
- />Réanimation Médicale et Toxicologique, Unité Inserm U942, Centre Hospitalier Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, 2, rue Ambroise Paré, 75010 Paris, France
- />Réanimation Polyvalente, Groupe Hospitalier Inter-Communal Le Raincy-Montfermeil, Montfermeil, France
- />Réanimation Polyvalente, Centre Hospitalier Régional René Dubost, Pontoise, France
- />Réanimation Polyvalente, Centre Hospitalier Régional Universitaire, Tours, France
- />Réanimation, Centre Hospitalier Delafontaine, Saint-Denis, France
- />Department of Intensive Care Experimental Medicine Laboratory, Centre Hospitalier Universitaire, Charleroi, Belgium
- />Réanimation Médicale, Centre Hospitalier Universitaire de Nancy Brabois, Vandoeuvre-les-Nancy, France
- />Réanimation Polyvalente, Hôpital Antoine Béclère, APHP, Clamart, France
- />Réanimation Polyvalente, Centre Hospitalier Départemental Les Oudairies, La Roche-Sur-Yon, France
- />Réanimation Médicale, Centre Hospitalier Inter-Communal, Poissy, France
- />Clinique des Cèdres-Cornebarrieu, Blagnac, France
- />Réanimation Médicale, Centre Hospitalier Universitaire Paris-Sud, APHP, Kremlin-Bicêtre, France
- />Medical-surgical intensive care unit, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
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12
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Oh TG, Cha WC, Jo IJ, Kang MJ, Lee DW. A survey-based study on the protocols for therapeutic hypothermia in cardiac arrest patients in Korea: focusing on the differences between level 1 and 2 centers. Clin Exp Emerg Med 2016; 2:210-216. [PMID: 27752600 PMCID: PMC5052908 DOI: 10.15441/ceem.15.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/11/2015] [Accepted: 10/02/2015] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE We aimed to summarize the therapeutic hypothermia (TH) protocols used in emergency departments (EDs) in Korea and to investigate the differences between level 1 and 2 centers. METHODS The chief residents from 56 EDs were given a structured survey containing questions on the indications for TH, methods for TH induction, maintaining, and finalizing TH treatments. The participants were divided into 2 groups based on their work place (level 1 vs. level 2 centers). RESULTS We received 36 responses to the survey. The majority of the participants (94.4%) reported that they routinely used TH. An average of 5.9 (standard deviation, 3.4) and 3.3 (standard deviation, 2.9) TH procedures were performed monthly in level 1 and 2 centers, respectively (P=0.01). The majority of level 1 and 2 centers (80.0% and 73.1%, respectively) had written TH protocols. Rectal (50.0%) and esophageal probes (38.9%) were most commonly used to monitor the patients' body temperatures. Midazolam (80.6%) and remifentanyl (47.2%) were the most commonly used sedatives. For TH induction, external cooling devices (77.8%) and cold saline infusion (66.1%) were predominant. Between level 1 and 2 centers, only the number of TH, the usage of remifentanyl, and application of external cooling device showed significant differences (P<0.05). CONCLUSION Our study summarizes the TH protocols used in 36 EDs. The majority of study participants performed TH using a written protocol. We observed small number of differences in TH induction and maintenance methods between level 1 and 2 centers.
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Affiliation(s)
- Tae Gwan Oh
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mun Ju Kang
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Dong Woo Lee
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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13
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Changes in Therapeutic Hypothermia and Coronary Intervention Provision and In-Hospital Mortality of Patients With Out-of-Hospital Cardiac Arrest: A Nationwide Database Study. Crit Care Med 2016; 44:488-95. [PMID: 26496447 DOI: 10.1097/ccm.0000000000001401] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the change in provision of therapeutic hypothermia and coronary intervention (postresuscitation care) over time and to clarify the association between these provisions and in-hospital mortality in patients with out-of-hospital cardiac arrest. DESIGN A nationwide retrospective cohort study using multiple propensity score analyses. SETTING Japanese Diagnosis Procedure Combination inpatient database. PATIENTS Adult patients with cardiogenic out-of-hospital cardiac arrest related to ventricular fibrillation were identified from July to December in 2008-2012 (385 hospitals; n = 3,413). MEASUREMENTS AND MAIN RESULTS We evaluated the proportion of patients receiving postresuscitation care and all-cause mortality at 30 days after out-of-hospital cardiac arrest. The proportion of postresuscitation care provision increased significantly over the study period (Mantel-Haenszel trend test, p < 0.001). The overall 30-day mortality was 52.0% (1,774/3,413), and the crude 30-day mortality decreased significantly during the study period (p = 0.006). Logistic regression analysis showed significant associations between the fiscal years 2011 and 2012 and 30-day mortality (2011: odds ratio, 0.75; 95% CI, 0.57-0.98 and 2012: odds ratio, 0.61; 95% CI, 0.47-0.81). Multiple propensity score analysis incorporating postresuscitation care showed that 30-day mortality was significantly associated with postresuscitation care, and the significant associations between 30-day mortality and the years 2011 and 2012 were no longer observed (2011: odds ratio, 1.05; 95% CI, 0.82-1.3 and 2012: odds ratio, 0.95; 95% CI, 0.74-1.2). CONCLUSIONS The 30-day survival rate of adult patients with cardiogenic out-of-hospital cardiac arrest related to ventricular fibrillation improved significantly after 2010 in Japan. This improvement may be associated with an increase in postresuscitation care provision.
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Kim YM, Lee SJ, Jo SJ, Park KN. Implementation of the guidelines for targeted temperature management after cardiac arrest: a longitudinal qualitative study of barriers and facilitators perceived by hospital resuscitation champions. BMJ Open 2016; 6:e009261. [PMID: 26733568 PMCID: PMC4716234 DOI: 10.1136/bmjopen-2015-009261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To identify the barriers to and facilitators of implementing guidelines for targeted temperature management (TTM) after cardiac arrest perceived by hospital resuscitation champions and to investigate the changes in their perceptions over the early implementation period. DESIGN A longitudinal qualitative study (up to 2 serial semistructured interviews over 1 year and focus groups). The individual interviews and focus groups were transcribed and coded by 2 independent assessors. Contents were analysed thematically; group interaction was also examined. SETTING 21 hospitals, including community and tertiary care centres in South Korea. PARTICIPANTS 21 hospital champions (14 acting champions and 7 managerial champions). RESULTS The final data set included 40 interviews and 2 focus groups. The identified barriers and facilitators could be classified into 3 major themes: (1) healthcare professionals' perceptions of the guidelines and protocols, (2) interdisciplinary and interprofessional collaboration and (3) organisational resources. Lack of resources was the most commonly agreed on barrier for the acting champions, whereas lack of interdisciplinary collaboration was the most common barrier for the managerial champions. Educational activities and sharing successfully treated cases were the most frequently identified facilitators. Most of the participants identified and agreed that cooling equipment was an important barrier as well as a facilitator of successful TTM implementation. Perception of the guidelines and protocols has improved with the accumulation of clinical experience over the study period. CONCLUSIONS Healthcare professionals' internal barriers to TTM implementation may be influenced by new guidelines and can be changed with the accumulation of successful clinical experiences during the early implementation period. Promoting interprofessional and interdisciplinary collaboration through educational activities and the use of cooling equipment with an automated feedback function can improve adherence to guidelines in hospitals with limited human resources in critical care.
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Affiliation(s)
- Young-Min Kim
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joon Lee
- Department of Emergency Medicine, Myongji Hospital, Goyang-si, Gyeonggi-do, Korea
| | - Sun Jin Jo
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Nam Park
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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15
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Wils EJ, van den Berg T, van Bommel J. Current practice of target temperature management post-cardiac arrest in the Netherlands, a post-TTM trial survey. Resuscitation 2015; 97:e1-2. [DOI: 10.1016/j.resuscitation.2015.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 10/22/2022]
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16
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Abstract
Since their introduction over 40 years ago, paramedics have been trained to deliver select advanced life support interventions in the community with the goal of reducing morbidity and mortality from cardiovascular disease and trauma. The ensuing decades witnessed a great deal of interest in paramedic care, with an exponential growth in prehospital resuscitation research. As part of the CJEM series on emergency medical services (EMS), we review recent prehospital research in out-of-hospital cardiac arrest and discuss how, in a novel departure from the origins of EMS, prehospital research is beginning to influence in-hospital care. We discuss emerging areas of study related to cardiopulmonary resuscitation (CPR) quality, therapeutic hypothermia, termination of resuscitation, and the use of end-tidal carbon dioxide measurement, as well as the subtle ripple effects that prehospital research is having on the broader understanding of the management of these critically ill patients.
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17
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Storm C. TTM 2.0. BMC Emerg Med 2015. [PMCID: PMC4480831 DOI: 10.1186/1471-227x-15-s1-a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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