Suffoletto Brian P, Salcido David D, Menegazzi James J
Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Prehosp Emerg Care. 2008 Jan-Mar;12(1):52-6. doi: 10.1080/10903120701707880.
Postresuscitation care of comatose survivors of cardiac arrest using induced hypothermia (IH) is recommended by the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR) to improve neurological outcomes but has been performed primarily later in the course of care. Recently, it was shown that prehospital cooling is feasible, safe, and effective in lowering patient temperature. We sought to determine the prevalence of EMS agencies that use prehospital IH. We also sought to determine what perceived barriers to initiating IH might exist and the understanding EMS physicians have of guidelines for IH.
We collected a convenience sample of completed questionnaires from physician members of the National Association of EMS Physicians at the national conference on 3 days from January 11 to 13, 2007.
One hundred forty-five (59%) physician members who had attended the conference completed the survey, representing 109 EMS Medical Directors and 36 non-Medical Director EMS Physicians from 92 regions of 34 U.S. states, three Canadian provinces, and one European country. A total of 9 of 145 (6.2%) of physicians stated that the EMS agency they are affiliated with uses a protocols for IH, 6 of whom were local EMS Medical Directors. The median (IQR) duration of having a protocol was 12 months (6-12), and all used either ice bags or cold IV fluid or a combination of the two. Among those who reported prehospital use of IH, only one of eight (12.5%) recall having cooled greater than 10% of eligible patients in the field. Common perceived barriers to IH include the following: overburden with other tasks (62.1%), short transport times (60.7%), lack of refrigeration equipment (60.0%), and receiving hospitals' failure to continue therapeutic hypothermia (56.6%). A small but significant percentage (22.1%) believed that the lack of guidelines specifically addressing prehospital cooling was a barrier to initiating a protocol, and only 62% correctly identified 32-34 degrees C as the recommended target temperature range.
The practice of prehospital IH is rare. Infrequent use of prehospital cooling seen in our select population may be due to the perceived barriers that were identified and/or inadequate guidance from the scientific literature. Statements from the AHA and ILCOR first published in 2003 and reiterated in 2005 recommend the implementation but do not specify the most beneficial time to initiate postresuscitation cooling of comatose survivors of cardiac arrest. Further studies should examine the relative benefit of prehospital cooling.
美国心脏协会（AHA）和国际复苏联合委员会（ILCOR）建议对心脏骤停昏迷幸存者采用诱导低温（IH）进行复苏后护理，以改善神经学转归，但该措施主要在护理后期实施。最近有研究表明，院前降温可行、安全且能有效降低患者体温。我们旨在确定采用院前IH的急救医疗服务（EMS）机构的比例。我们还试图确定启动IH可能存在哪些可感知的障碍，以及EMS医生对IH指南的理解情况。
我们从2007年1月11日至13日全国会议上的美国急诊医师协会医师会员中收集了一份完成问卷的便利样本。
145名（59%）参会医师会员完成了调查，代表来自美国34个州92个地区、加拿大3个省和1个欧洲国家的109名EMS医疗主任和36名非医疗主任EMS医师。145名医师中共有9名（6.2%）表示他们所属的EMS机构使用IH方案，其中6名是当地EMS医疗主任。有方案的中位（四分位间距）时长为12个月（6 - 12个月），且所有机构均使用冰袋或冷静脉输液或两者结合的方式。在报告院前使用IH的人员中，只有八分之一（12.5%）记得在现场对超过10%的符合条件患者进行了降温。IH常见的可感知障碍包括：其他任务负担过重（62.1%）、转运时间短（60.7%）、缺乏制冷设备（60.0%）以及接收医院未能继续进行治疗性低温（56.6%）。一小部分但有显著比例（22.1%）的人认为缺乏专门针对院前降温的指南是启动方案的障碍，只有62%的人正确将32 - 34摄氏度识别为推荐的目标温度范围。
院前IH的应用很少见。在我们选定人群中院前降温使用不频繁可能是由于已确定的可感知障碍和/或科学文献中指导不足。AHA和ILCOR于2003年首次发表并于2005年重申的声明建议实施，但未明确指出对心脏骤停昏迷幸存者进行复苏后降温的最有益启动时间。进一步研究应考察院前降温的相对益处。
