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Therapeutic hypothermia following out-of-hospital cardiac arrest; does it start in the emergency department?
  1. R Galloway1,
  2. P B Sherren2
  1. 1Department of Emergency Medicine, Kent and Sussex hospitals, UK
  2. 2Department of Intensive Care, The Royal London hospital, Whitechapel, London, UK
  1. Correspondence to Galloway R, Department of Emergency Medicine, Kent and Sussex hospitals, United Kingdom; drrobertgalloway{at}gmail.com

Abstract

Background The use of therapeutic hypothermia after cardiac arrest is a well-practised treatment modality in the intensive care unit (ICU). However, recent evidence points to advantages in starting the cooling process as soon as possible after the return of spontaneous circulation (ROSC). There are no data on implementation of this treatment in the emergency department.

Methods A telephone survey was conducted of the 233 emergency departments in the UK. The most senior available clinician was asked if, in cases where they have a patient with a ROSC after an out-of-hospital cardiac arrest, would therapeutic hypothermia be started in the emergency department.

Results Of the 233 hospitals called, 230 responded, of which 35% would start cooling in the emergency department. Of this 35%, over half (56%) said the decision to start cooling was made by the emergency physician before consultation with the ICU. Also, of the 35% who would begin cooling in the emergency department, 55% would cool only for ventricular fibrillation/ventricular tachycardia, 66% would monitor temperature centrally, and 14% would use specialised cooling equipment.

Conclusions There is often a delay in getting patients to ICU from the emergency department, and thus the decision not to start cooling in the emergency department may impact significantly on patient outcome. The dissemination of these data may persuade emergency physicians that starting treatment in the emergency department is an appropriate and justifiable decision that is becoming a more accepted practice throughout the UK.

  • Out-of-hospital cardiac arrest
  • therapeutic hypothermia
  • intensive care
  • emergency department
  • emergency care systems
  • intensive care
  • management
  • emergency department management
  • resuscitation

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Footnotes

  • Presented at the Annual DINGLE Conference 2009 (Intensive Care Society of Ireland).

  • Funding This paper did not receive any grant or funding from any agency in the public, commercial or not-for-profit sector.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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