Skip to main content

Employing knowledge translation interventions to increase the use of therapeutic hypothermia post arrest: the SPARC Network Trial

Introduction

Current guidelines recommend early institution of therapeutic hypothermia (TH) in survivors of out-of-hospital cardiac arrest (OHCA). However, recent surveys show that TH is delivered inconsistently, incompletely, and with undue delay. Targeted knowledge translation (KT) strategies may increase the proportion of OHCA patients receiving TH

Methods

We conducted a stepped-wedge cluster randomized trial to evaluate the effectiveness of a multi-faceted KT strategy for increasing TH use in a network of 37 hospitals. After a baseline period of 1 year, four wedges of six hospitals were randomized to receive 1 year of passive KT followed by 4 months of active KT. Passive KT included a generic protocol and order set; active KT included network events, performance feedback and ongoing nurse educator support. The primary outcome was the rate of successful TH, defined as a temperature of 32 to 34°C within 6 hours of emergency department (ED) arrival.

Results

During the study 4,742 OHCA patients were transported to hospital and 1,063 (22%) were eligible for TH. Overall, both KT interventions were effective at increasing the rate of successful TH (Figure 1), and passive KT led to marked improvements over baseline (96/395 vs. 30/320 patients; OR = 2.24, 95% CI = 1.54 to 3.26; P < 0.05). Active KT did not improve the primary outcome compared with passive KT (86 of 348 patients with active KT; OR = 0.94, 95% CI = 0.70 to 1.28; P = 0.70); however, it did significantly increase rates of initiating TH in the ED (P = 0.04). Inappropriate TH remained rare (5 to 6% of patients) during both KT phases.

Figure 1
figure1

Successful TH across KT interventions.

Conclusions

A multifaceted KT intervention markedly improved rates of TH in a large network of hospitals. Simple passive KT strategies were highly effective in increasing TH rates, whereas more active KT improved the use of TH in the ED.

Author information

Affiliations

Authors

Corresponding author

Correspondence to LJ Morrison.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Morrison, L., Dorian, P., Dainty, K. et al. Employing knowledge translation interventions to increase the use of therapeutic hypothermia post arrest: the SPARC Network Trial. Crit Care 15, P308 (2011). https://doi.org/10.1186/cc9728

Download citation

Keywords

  • Emergency Department
  • Cardiac Arrest
  • Knowledge Translation
  • Baseline Period
  • Therapeutic Hypothermia