Therapeutic hypothermia following out-of-hospital cardiac arrest (OHCA): an audit of compliance at a large Australian hospital

Therapeutic hypothermia (TH) is now largely considered the standard of care for patients following out-of-hospital cardiac arrest caused by ventricular arrhythmias, although the effective implementation of TH for individual patients can be challenging. This study aimed to document the effectiveness of TH when it is used at the discretion of treating physicians and not under the auspices of a research trial or protocol. A retrospective review of intensive care unit admissions over a four-year period detected 43 patients appropriate for TH. In the emergency department, only 20% of patients had TH commenced. Forty-four percent of patients required angiography in the cardiac catheterisation laboratory. It took, on average, 595 minutes for patients to reach their goal temperature, which was not reached at all in 13% of patients. Nineteen patients (44%) had a positive neurological outcome while 24 patients (56%) either died or had a poor neurological outcome. Without the control of a hospital protocol it was apparent that the implementation of TH in patients with an out-of-hospital cardiac arrest in our institution was inadequate. We recommend that TH is undertaken within the framework of a protocol that encompasses all the relevant departments.