Paweł Krawczyk

Implementation of therapeutic hypothermia after cardiac arrest in intensive care units in Poland

BACKGROUND Therapeutic hypothermia (TH) is one of few interventions that improve survival after a cardiac arrest with good neurological outcome. Current guidelines for cardiopulmonary resuscitation recommend TH in comatose adult patients after return of spontaneous circulation (ROSC) regardless of cardiac arrest location and cardiac rhythm during the event. AIM To evaluate level of TH implementation in intensive care units (ICUs) in Poland and identify barriers to the implementation process. METHODS A telephone survey was carried out to determine how many Polish ICUs were using TH in the management of comatose patients after a cardiac arrest. The survey was conducted from October to December 2010. The survey also included questions on the number of patients cooled, method of TH induction and maintenance, target temperature, duration of cooling, and cardiac arrest rhythm in patients treated with TH. We have also collected data on pre-hospital use of TH and potential barriers to implementation of TH. RESULTS We obtained information from 263 of 464 ICUs (56.8%) in Poland. At the time of the survey, 57 ICUs (21.7%) were using TH in comatose patients after ROSC. There was a significant increase in the number of ICUs using TH as compared with the 2005 survey. Most ICUs did not use any sophisticated equipment to induce and maintain TH. Ninety six percent of ICUs were using TH regardless of the cardiac arrest rhythm. In 65% of ICUs (37 units), target temperature was 32-34°C and 63% of ICUs (36 units) maintained TH for 12-24 hours. An increase in ICU experience in TH can be noted: 61% of ICUs (35 units) declared TH use in more than 10 patients during the last year. We found the following barriers to implementation of TH: lack of knowledge, lack of local protocols, lack of equipment, and economic issues. CONCLUSIONS The number of ICUs using TH in Poland increased threefold in the 5 year period of 2005-2010. However, the proportion of ICUs using TH is still low (21.7%) compared to other European countries. Further efforts should be undertaken to reduce barriers to implementation of current resuscitation guidelines.

A survey on general and temperature management of post cardiac arrest patients in large teaching and university hospitals in 14 European countries—The SPAME trial results

INTRODUCTION International guidelines recommend a bundle of care, including targeted temperature management (TTM), in post cardiac arrest survivors. Aside from a few small surveys in different European countries, adherence to the European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) recommendations are unknown. METHODS This international European telephone survey was conducted to provide an overview of current clinical practice of post cardiac arrest management with a main focus on TTM. We targeted large teaching and university hospitals within Europe as leading facilities and key opinion leaders in the field of post cardiac arrest care. Selected national principal investigators conducted the survey, which was based on a predefined questionnaire, between December 2014 and March 2015, before the publication of the ERC Guidelines 2015. RESULTS The return rate was 94% from 268 participating intensive care units (ICU). The majority had a predefined standard operating procedure (SOP) protocol for post cardiac arrest patients. Altogether, 68% of the ICUs provided TTM at a target temperature of 32-34°C for 24h, and 33% had changed the target temperature to 36°C. The minority provided a written SOP for neurological prognostication, which was generally initiated 72h after return of spontaneous circulation (ROSC). Electroencephalography and somatosensory evoked potentials were used by most ICUs for early prognostication. Treating more than fifty patients a year was significantly associated with providing written SOPs for TTM and prognostication (p<0.01), as well as the use of a computer feedback device (p=0.03) for TTM. CONCLUSION This international European telephone survey revealed a high rate of implementation of TTM in post cardiac arrest patients in university and teaching hospitals. Most participants also provided a SOP, but only a minority had a SOP for neurological prognostication.

Implementation of targeted temperature management after cardiac arrest in Polish intensive care units. What has changed in the last five years

BACKGROUND Studies conducted up to 2010 indicate the underuse of targeted temperature management (TTM) in Poland. AIM This study evaluated the current degree of TTM implementation in Polish intensive care units (ICUs) and analysed the implementation process since 2010. METHODS A telephone survey, conducted from December 2014 to July 2015, was carried out to determine the number of ICUs using TTM in patients after cardiac arrest. We collected data on the details and prevalence of TTM, and the impact of organisational and financial issues and recently published papers on its use. RESULTS We obtained data from 271 of 396 ICUs (68.4%). In total, 79 (29.2%) ICUs indicated TTM use and 27 (34.2%) used dedicated TTM equipment. Overall, 62% of the ICUs used TTM regardless of the cardiac arrest rhythm. Target temperatures of 32-34°C and 34.1-36°C were reached by 44.3% and 43.0% of ICUs, respectively. The duration of TTM was 12-24 h in 58.2% of the ICUs. The most common barriers to TTM implementation were a lack of dedicated devices (36.3%) and organ-isational and logistical issues (31.2%). Any influence of recently published data on TTM practice modifications was reported by only 23.4% of the ICUs. CONCLUSIONS Targeted temperature management is underused in Polish ICUs. There is a need for additional educational and implementation efforts supporting the translation of knowledge into clinical practice at the regional and national levels.

AP064 Manual defibrillation according to the 2010 European Resuscitation Council (ERC) Guidelines – Is there a consensus? Report from 6th International Emergency Medicine Championships

p<0.05, airway opening p<0.05 and breathing assessment p<0.05, respectively between the age of students with assessment of consciousness p<0.01 and breathing assessment p<0.05. Conclusions: We considered that the most important factors that can influence the level of knowledge’s acquisition necessary for effective BLS maneuvers are younger age and the presence of medical background in participants. In light of the objectives of this study shows the need to put more emphasis on preparing students with medical background present, to be sure that they will purchase during clinical placements and course information necessary to make correct and effective resuscitation maneuvers.

Patients with small-vessel vasculitides have the highest mortality among systemic autoimmune diseases patients treated in intensive care unit: A retrospective study with 5-year follow-up

Purpose: Systemic autoimmune diseases are a heterogeneous group of disorders associated with dysfunction of multiple organs and unpredictable course. Complicated management and treatment become even more challenging when patients require critical care. This study aims to compare outcomes of small‐vessel vasculitides (SVV) and other systemic autoimmune diseases (SAD) patients admitted to the intensive care unit (ICU). Materials and methods: Retrospective, observational study conducted in the ICU of Allergy and Immunology Department at the University Hospital in Krakow, Poland, between years 2001–2014, with 5‐years follow‐up and no lost to follow‐up patients. Results: 74 patients with autoimmune diseases were enrolled in the study ‐ 23 with SVV and 51 with SAD. Patients in the SVV group achieved higher scores in APACHE II and III SAPS II and SOFA at ICU admission. The SVV patients required renal replacement techniques, blood products transfusion and immunosuppressive treatment more often. SVV patients had higher ICU mortality (60.9% vs. 35.3%, p = .04), however after discharge from ICU, in long term follow‐up (1 year and 5 years) mortality was similar in both studied groups. Conclusions: Among systemic autoimmune diseases small vessel vasculitides appear to be associated with the highest ICU mortality, higher requirement for advanced procedures and aggressive immunosuppressive therapy.

Implementation of the modified four-step approach method for teaching echocardiography using the FATE protocol-A pilot study

Peytons four‐step approach is well‐known and commonly used in medical education. It is a practical and useful method which is simple to apply. The study presents the implementation of the modified four‐step approach method to teach how to perform the emergency echocardiographic assessment according to FATE (Focus‐Assessed Transthoracic Echo) protocol. The aim of the study was to determine the feasibility and utility of this method FATE protocol teaching.