Prehospital hypothermia after cardiac arrest. A survey of the emergency physician-based ambulance system in Baden-Wuerttemberg Germany

Backround: International guidelines recommend initiation of mild therapeutic hypothermia in unconscious patients after cardiac arrest as soon as possible and clinical studies have shown the practicability and efficiency of prehospital-induced hypothermia. Methods: In this study a survey of the emergency physician-based ambulance system in Baden-Wuerttemberg, a German State with about 10.7 million inhabitants, was performed to evaluate treatment and strategies of patients after prehospital cardiac arrest with the focus on out-of-hospital induction of hypothermia, logistics and the existence of algorithms in the emergency medical service. Results: Only 17.7% of all emergency physician-based ambulance services in Baden-Wuerttemberg frequently treat patients with hypothermia before hospital admission. Logistical problems seem to be the main reasons not to induce hypothermia in the field. Therapeutic mild hypothermia is more often practiced in specialized cardiac arrest centres and 53.1% of all emergency physician bases have standardized algorithms available. The algorithms lead to frequent and more consistent implementation of prehospital treatment strategies. Conclusions: In the emergency physician-based ambulance system in Baden-Wuerttemberg after successful resuscitation only 20% of patients are treated with hypothermia before hospital admission. The specific use of algorithms in emergency medical services increases the implementation of international recommendations. © Springer-Verlag 2012.