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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2010 August;76(8):617-23
The practice of therapeutic mild hypothermia in cardiac arrest survivors in the Czech republic
Skulec R. 1, Truhlár A. 2,3, Knor J. 1, Seblová J. 1, Cerny V. 3 ✉
1 Emergency Medical Service of the Central Bohemian Region, Kladno, Czech Republic;
2 Hradec Kralove Region Emergency Medical Services, Hradec Kralove, Czech Republic;
3 Department of Anesthesiology and Intensive Care, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
BACKGROUND: The proper performance of therapeutic mild hypothermia (TH) in cardiac arrest survivors is a prerequisite for achieving the best possible outcome. We analyzed the recent technical issues of in-hospital TH practices in the Czech Republic.
METHODS: As the second project of the PRE-COOL (Pre-hospital Cooling in Cardiac Arrest Patients) working group, we compiled the directory of all non-surgical intensive care units (ICUs) in the Czech republic. A head physician of every ICU was provided a structured questionnaire in October 2008.
RESULTS: From a total of 487 ICUs that were sent the questionnaire, 41.5% responded. We analyzed the responders that provide early post-resuscitation care, including TH (N=90). The site of TH initiation was most frequently an ICU bed (93.3%). A broad TH indication irrespective of the initial rhythm, cardiac arrest location or the presence of witnesses was reported by 48.9% of the responders. Up to 81.1% of the responding ICUs did not exclude from TH therapy patients who were developing post-resuscitation shock. Complex neuroprotective and cardioprotective approaches (TH, urgent coronary intervention, control of glycemia and early goal-directed hemodynamic support) were practiced at 52.2% of the ICUs. Of the responders, 54.4% cooled patients for 24 hours. The most frequently used cooling techniques were surface cooling with ice packs (88.9%) and intravenous cold infusion (84.4%).
CONCLUSION: The survey revealed the recent practice of TH management of cardiac arrest survivors in the Czech republic. The modes of TH practice were different in many aspects, and unifying the basic components is advisable.