Cooling Cardiac Arrest Patients Is Slow to Catch On

As of January 1, 2009, New York City emergency medical services (EMS) have undertaken to take resuscitated cardiac arrest patients only to hospitals where they can receive therapeutic hypothermia. Boston, Seattle, and Miami have similar policies already in place. However, this form of treatment is not widely adapted.

The neuroprotective benefits of hypothermia are well-established, according to the International Liaison Committee on Resuscitation (ILCOR), whose report is to be published online in the journal Circulation. The statement says: “Therapeutic hypothermia should be part of standardized treatment strategy for comatose survivors of cardiac arrest.”

Two surveys have recently tried to ascertain why this form of treatment is not yet widely used. The first, published in 2006 in Critical Care Medicine, sent out 13,250 surveys to physicians concerned with critical care, cardiology, and emergency medicine in the USA, UK, and Finland. There were only 17% replies. Among those US physicians who replied, only 26% had actually used hypothermia. The reasons given for poor implementation were: “not enough data”, “not part of the guidelines”, and “too technically difficult”.

The second survey, which was reported in 2008 in Prehospital Emergency Care, was based on surveys administered at the National Association of EMS Physicians conference in 2007. There was a 60% completion rate. Hypothermia had been in use for about a year in 6.2% of centers – ice bags or cold IV fluids or a combination of both. However, only one in ten cases of cardiac arrest resulted in hypothermia. Reasons for not employing it were: “overburdened with other tasks”, “short transport times”, “no refrigerator equipment”, and “failure of receiving hospital to continue hypothermia”.

Considering that clinical trials showing the effectiveness of hypothermia in cardiac arrest were reported over 6 years ago, the situation regarding widespread implementation is disappointing. Maybe when the latest ILCOP recommendations are published, more attention will be given to this life-saving procedure.