Nationwide survey of hypothermia after cardiac arrest in Croatia

Introduction: The use of mild therapeutic hypothermia (MTH) has been shown to improve survival and neurological outcome of comatose survivors who recovered spontaneous circulation after cardiac arrest. Although the evidence supporting the method is strong and it has entered the guidelines for resuscitation, implementation of this method is still low: according to recently published data, 87% of physicians and 76% of German ICUs did not use the method. In this survey we investigated current implementation of MTH in Croatia. Methods: A questionnaire was created and served as basis for a structured interview. A list of all Croatian hospitals was obtained from the Croatian Health Ministry. All hospitals were contacted by phone or personal visits and interviews were lead in December 2007. Results: There are 24 general 8 university hospitals in Croatia and we conducted the interview in all but two. In those 30 hospitals, there are 33 ICUs admitting patients after cardiac arrest: 15 mixed surgical/medical, 11 coronary care units and 7 general medical ICUs. Only 9% ICUs used MTH as standard method, all in university hospitals. Ice-cold infusions and ice packs in combination are methods of cooling in all three. Of those that do not use the method 10% are planning to start using it soon, 7% are not aware of the method, 20% claim it is technically too difficult, 7% claim it is too costly and 7% need more proof of efficiency. Most ICUs (48%) gave no reason for not using the method. Conclusion: Even with the ICUs planning to start using MTH after cardiac arrest, its implementation in is unacceptably low. The reasons given for not using it suggest lack of knowledge and a nationwide program promoting the method and its benefits could be the best way for improving the implementation.