Predictors of adopting therapeutic hypothermia for post-cardiac arrest patients among Canadian emergency and critical care physicians

Abstract

Therapeutic hypothermia improves outcomes in resuscitated cardiac arrest patients, but prior application rates are less than 30%. We sought to evaluate self-reported physician adoption, predictors of adoption, and barriers to use among Canadian emergency and critical care physicians. A web-based modified Dillman questionnaire asked all physicians on the membership lists of the Canadian Association of Emergency Physicians and the Canadian Critical Care Forum physicians to report their experience with therapeutic hypothermia using the Pathman framework of changing physician behaviour. We used logistic regression to explore the association between physician and practice variables and the adoption of therapeutic hypothermia. We surveyed 1264 physicians; 39% responded. Most (78%) were emergency physicians, 54% worked at tertiary care hospitals, 62% treated >10 arrests annually and 50% had standardized cooling protocols. Most respondents were aware of therapeutic hypothermia (99%) and agreed that it is beneficial (91%), but only two-thirds (68%) had used it in clinical practice. Predictors for adopting therapeutic hypothermia included critical care field of practice (OR 6.3, 95% CI 2.5-16.0), availability of a cooling protocol (OR 5.6, CI 3.1-10.0), being <10 years post-residency (OR 2.0, CI 1.2-3.3), and treating >10 cardiac arrests annually (OR 2.6, CI 1.6-4.1). Common barriers included: lack of awareness of recommended practice (31%), perceptions of poor prognosis (25%), too much work required to cool (20%) and staffing shortages (20%). Therapeutic hypothermia after cardiac arrest has not been universally adopted. Adoption might be improved through protocol implementation, education about benefits and prognosis, and strategies to make administration easier.