A nationwide survey on the use of mild therapeutic hypothermia after cardiac arrest in German intensive care units - the impact of guidelines on the implementation of a new therapeutic option into clinical practice

To investigate the implementation of mild therapeutic hypothermia (MTH) after cardiac arrest into clinical practice a structured evaluation questionnaire was sent to all German hospitals registered for providing intensive care units (ICUs), 438 (57%) of those having completed the survey. A total of 311 ICUs (69% of responders) reported to use MTH. As stated by the intensive care physicians, scientific evidence and the recommendation of MTH by the current guidelines were the main reasons to implement MTH into clinical practice. Many centers use inexpensive cold packs (93%) and cold infusions (97%). MTH was considered to be a safe and efficient method regardless what cooling method was used. Users of cooling catheters, however, rated MTH more often to be costly than users of other cooling methods. Besides the low evidence of benefit, a significant amount of ICUs follow the guidelines and also initiate MTH in patients after in-hospital cardiac arrest (84%) or when initial rhythms other than ventricular fibrillation were observed (74%). Conclusions: Implementation of MTH into clinical practice is a long lasting process, but recommendations by the European guidelines on advanced cardiovascular life support have significantly increased the use of MTH in Germany.