Therapeutic hypothermia (TH) is a fairly new and innovative procedure designed to improve neurologically intact survival from out-of-hospital cardiac arrest (OHCA). The procedure involves reducing the body's core temperature for an extended period of time (e.g., 12–24 hours) during postarrest treatment. Research has demonstrated the efficacy of TH for improving neurologically intact survival after OHCA.
National guidelines have called for the use of TH on OHCA survivors since 2005. A variety of barriers, however, have limited the widespread adoption of TH. Some providers remain skeptical about the procedure's effectiveness, while others believe it is too complex to implement successfully. Other barriers include lack of knowledge, experience, personnel, resources, and infrastructure.
A new study characterizes the adoption and implementation of TH by general acute care hospitals in New Jersey. After growing slowly from 2004 to 2008, TH use among New Jersey hospitals accelerated between 2009 and 2011. By 2011, 68.4% of New Jersey hospitals had a TH program in place, with an additional 13.6% indicating plans to begin one. Most hospitals indicated low volumes of OHCA patients (e.g., ≤10 per month). There was no relationship between OHCA volume and development of a TH program. The per hospital volume of OHCA patients receiving TH is even lower given the extensive patient exclusion criteria used by many facilities. TH hospitals vary widely in their TH exclusion criteria and cooling equipment and methods.
The vast majority of New Jersey hospitals are now organized to implement national TH guidelines for initial survivors of OHCA. However, limited volumes of OHCA cases per hospital and lack of uniformity on how the guidelines are implemented raise new questions about the effectiveness of current practice in postarrest care. More detailed analysis of TH volumes versus outcomes and comparative studies of TH techniques are required to optimize postarrest care.
SOURCE: Therapeutic Hypothermia and Temperature Management