Therapeutic hypothermia in Italian Intensive Care Units after 2010 resuscitation guidelines: Still a lot to do

Gasparetto, Nicola; Scarpa, Daniele; Rossi, Sandra; Persona, Paolo; Martano, Luigi; Bianchin, Andrea; Castioni, Carlo Alberto; Ori, Carlo; Iliceto, Sabino; Cacciavillani, Luisa

doi:10.1016/j.resuscitation.2013.11.014

Cited by 21 publications

(14 citation statements)

References 29 publications

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“…The most popular methods of cooling in Polish ICUs are cold intravenous fluids for induction and ice packs for maintenance. Similar to the Italian study [17], 36% of our respondents cited lack of equipment as the reason for not using TTM. There is no contraindication for using TTM without specific equipment; despite more precise temperature control, reduced latency in reaching the target temperature (when 32-34°C is chosen as the target), and less nursing staff workload, there is no evidence of better patient outcomes when using dedicated equipment [22,23].…”

Section: Discussionsupporting

confidence: 84%

“…This represents a major change compared with a 2010 assessment, during which no ICU declared use of equipment for internal cooling and only 9% (5/57) used dedicated external TTM devices (Table 3; c 2 , p < 0.001). However, 34.2% remains a very low proportion when compared with recently published studies from Italy or Germany that demonstrated the use of dedicated TTM equipment in 75% and 78% of cases, respectively [17,21]. The most popular methods of cooling in Polish ICUs are cold intravenous fluids for induction and ice packs for maintenance.…”

Section: Discussionmentioning

confidence: 96%

“…3) [11,12]. A recently published paper analysing TTM use among Italian ICUs also showed TTM underuse [17]; however, the increase in rate of TTM use in ICUs in Italy has exceeded that in Poland since 2005 (increases of 68% and 36.5% per year, respectively). Table 3 compares the key elements of TTM in studies done in 2010 and 2015 in Poland.…”

Section: Discussionmentioning

confidence: 98%

“…However, there was an unequal distribution of ICUs using TTM within the country, with greater TTM use in central and eastern Poland; regional to reimburse ICUs for the use of TTM. The economic aspects associated with introducing TTM have been discussed in other studies; however, in those studies, cost appeared also to not represent a major barrier to use [17]. Other reasons indicated in previous studies for ICUs not using TTM include a lack of ready-to-use protocols and a lack of strong evidence of the effectiveness of TTM from prospective, high-quality RCTs.…”

Section: Discussionmentioning

confidence: 99%

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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?

Krawczyk

Tarczynska²,

Dziadek³

et al. 2017

Kardiol Pol

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A b s t r a c tBackground: 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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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Krawczyk

Tarczynska²,

Dziadek³

et al. 2017

Kardiol Pol

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“…Despite the AHA guideline recommendation, only a fraction of eligible patients were being cooled in hospital emergency departments and intensive care units. [51][52][53] Directly or indirectly, this led to an increased emphasis on EMS initiation of cooling in the field immediately following ROSC. 54,55 Recently, the conversation around the optimal use of therapeutic hypothermia has intensified with two large randomized trials failing to show a survival advantage for cooled patients.…”

Section: Therapeutic Hypothermiamentioning

confidence: 99%

The impact of prehospital resuscitation research on in-hospital care

Mausz

Cheskes

2015

CJEM

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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. RÉSUMÉDepuis leur arrivée il y a plus d'une quarantaine d'années, les ambulanciers paramédicaux sont formés pour pratiquer certaines interventions de réanimation cardiorespiratoire (RCR) médicalisée dans la collectivité dans le but de réduire la morbidité et la mortalité liées aux maladies cardiovasculaires et aux traumas. Au cours des décennies suivantes, les soins paramédicaux ont suscité un vif intérêt, qui s'est accompagné d'une forte croissance de la recherche en réanimation préhospitalière. Dans le cadre de la série d'articles portant sur les services médi-caux d'urgence (SMU) dans le JCMU, il sera question de la recherche récente sur la prise en charge préhospitalière des arrêts cardiaques qui surviennent dans la collectivité ainsi que de l'influence que commence à avoir la recherche dans le domaine préhospitalier sur les soins hospitaliers, influence qui signe une nouvelle orientation par rapport au point de départ des SMU. L'article portera sur de nouveaux champs d'étude liés à la qualité de la RCR, à l'hypothermie thérapeutique, à l'arrêt des manoeuvres de réanimation et à l'utilisation de la mesure du gaz carbonique en fin d'expiration ainsi que sur les effets d'entraînement discrets que la recherche dans le domaine préhospitalier a sur la compréhension élargie du traitement des personnes gravement malades ou blessées.

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Therapeutic Hypothermia in the Intensive Care Unit

Girardis

Biagioni

2015

Practical Issues Updates in Anesthesia and Intensive Care

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Therapeutic hypothermia in Italian Intensive Care Units after 2010 resuscitation guidelines: Still a lot to do

Cited by 21 publications

References 29 publications

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

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

The impact of prehospital resuscitation research on in-hospital care

Therapeutic Hypothermia in the Intensive Care Unit

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