Therapeutic hypothermia for postcardiac arrest patients: physicians are warming up to the idea

Introduction

Therapeutic hypothermia (TH) improves survival and neurologic recovery in resuscitated cardiac arrest patients. However, three published surveys with low response rates (<20%) reported most physicians have never used TH. We sought to evaluate current physician use, and barriers to use, of TH in Canada.

Methods

We developed a web-based questionnaire asking physicians to self-report their experience with TH using the Pathman framework of changing physician behavior. We surveyed all members of the Canadian Association of Emergency Physicians and the Canadian Critical Care Forum using the Dillman survey method between 19 March and 21 May 2008. Adjusted odds ratios were generated from a multiple logistic regression model that included all reported predictor variables.

Results

We surveyed 1,266 physicians, and 37% responded. Most (78%) respondents were emergency physicians, 54% worked at academic/tertiary-care hospitals, and 62% treated more than 10 arrests annually. Almost all respondents were aware of TH (99%) and agreed that TH was beneficial (91%), but only two-thirds (68%) had used TH in clinical practice. Only one-half (50%) reported using standardized cooling protocols. Critical care physicians were more likely to use TH than emergency physicians (93% vs. 61%, OR = 6.3, 95% CI = 2.5 to 16.0) and physicians who worked at a facility with a cooling protocol were more likely to use TH than their colleagues at other facilities (86% vs. 43%, OR = 5.6, 95% CI = 3.1 to 10.0). Physicians ≤ 10 years post residency were more likely to have used TH (73% vs. 63%, OR = 2.0, 95% CI = 1.2 to 3.3) as were physicians who treated >10 cardiac arrests annually (78% vs. 53%, OR = 2.6, 95% CI = 1.6 to 4.1). The use of TH was similar comparing academic/tertiary-care hospitals with community hospitals (OR = 1.6, 95% CI = 0.92 to 2.88). Common barriers reported by physicians included: lack of awareness (31%), perceptions of futility or poor prognosis (25%), too much work required to cool (20%) and staffing shortages (20%).

Conclusion

Self-reported adoption of TH is higher than previously reported at 68% among Canadian emergency and critical care physicians. Adoption is more likely by critical care physicians, those with protocols, and those treating >10 arrests annually. Several barriers were reported; overcoming these may improve the adoption of TH.