Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2011

Open Access 01-12-2011 | Study protocol

A knowledge translation collaborative to improve the use of therapeutic hypothermia in post-cardiac arrest patients: protocol for a stepped wedge randomized trial

Authors: Katie N Dainty, Damon C Scales, Steve C Brooks, Dale M Needham, Paul Dorian, Niall Ferguson, Gordon Rubenfeld, Randy Wax, Merrick Zwarenstein, Kevin Thorpe, Laurie J Morrison

Published in: Implementation Science | Issue 1/2011

Login to get access

Abstract

Background

Advances in resuscitation science have dramatically improved survival rates following cardiac arrest. However, about 60% of adults that regain spontaneous circulation die before leaving the hospital. Recently it has been shown that inducing hypothermia in cardiac arrest survivors immediately following their arrival in hospital can dramatically improve both overall survival and neurological outcomes. Despite the strong evidence for its efficacy and the apparent simplicity of this intervention, recent surveys show that therapeutic hypothermia is delivered inconsistently, incompletely, and often with delay.

Methods and design

This study will evaluate a multi-faceted knowledge translation strategy designed to increase the utilization rate of induced hypothermia in survivors of cardiac arrest across a network of 37 hospitals in Southwestern Ontario, Canada. The study is designed as a stepped wedge randomized trial lasting two years. Individual hospitals will be randomly assigned to four different wedges that will receive the active knowledge translation strategy according to a sequential rollout over a number of time periods. By the end of the study, all hospitals will have received the intervention. The primary aim is to measure the effectiveness of a multifaceted knowledge translation plan involving education, reminders, and audit-feedback for improving the use of induced hypothermia in survivors of cardiac arrest presenting to the emergency department. The primary outcome is the proportion of eligible OHCA patients that are cooled to a body temperature of 32 to 34°C within six hours of arrival in the hospital. Secondary outcomes will include process of care measures and clinical outcomes.

Discussion

Inducing hypothermia in cardiac arrest survivors immediately following their arrival to hospital has been shown to dramatically improve both overall survival and neurological outcomes. However, this lifesaving treatment is frequently not applied in practice. If this trial is positive, our results will have broad implications by showing that a knowledge translation strategy shared across a collaborative network of hospitals can increase the number of patients that receive this lifesaving intervention in a timely manner.

Trial Registration

ClinicalTrials.gov Trial Identifier: NCT00683683
Appendix
Available only for authorised users
Literature
1.
Green RS, Howes DW: Stock your emergency department with ice packs: a practical guide to therapeutic hypothermia for survivors of cardiac arrest. CMAJ. 2007, 176 (6): 759-62.CrossRefPubMedPubMedCentral
2.
Nolan JP, International Liaison Committee on Resuscitation; Emergency Cardiovascular Care Committee, American Heart Association; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiopulmonary, Perioperative, and Critical Care; Council on Clinical Cardiology; Council on Stroke: Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication: a scientific statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke (Part II). Int Emerg Nurs. 2010, 18 (1): 8-28. 10.1016/j.ienj.2009.07.001.CrossRefPubMed
3.
Howes D, Green R, Gray S, Stenstrom R, Easton D: Canadian Association of Emergency Physicians. Evidence for the use of hypothermia after cardiac arrest. CJEM. 2006, 8 (2): 109-15.PubMed
4.
The Hypothermia after Cardiac Arrest Study Group: Mild Therapeutic Hypothermia to Improve Neurologic Outcome after Cardiac Arrest. N Engl J Med. 2002, 346 (8): 549-56. 10.1056/NEJMoa012689.CrossRef
5.
Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002, 346 (8): 557-63. 10.1056/NEJMoa003289.CrossRefPubMed
6.
Mori K, Takeyama Y, Itoh Y: Multivariate analysis of prognostic factors in survivors of out-of-hospital cardiac arrest with brain hypothermia therapy. Crit Care Med. 2000, 28: A168-
7.
Benson DW, Williams GR, Spencer FC, Yates AJ: The Use of Hypothermia after Cardiac Arrest. Anesth Analg. 1959, 38: 423-8. 10.1213/00000539-195911000-00010.CrossRefPubMed
8.
Bernard SA, Jones BM, Horne MK: Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest. Ann Emerg Med. 1997, 30 (2): 146-53. 10.1016/S0196-0644(97)70133-1.CrossRefPubMed
9.
Bernard S, Buist M, Monteiro O, Smith K: Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation. 2003, 56 (1): 9-13. 10.1016/S0300-9572(02)00276-9.CrossRefPubMed
10.
Holzer M, Bernard SA, Hachimi-Idrissi S, Roine RO, Sterz F, Mullner M, on behalf of the Collaborative Group on Induced Hypothermia for Neuroprotection After Cardiac Arrest: Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis. Crit Care Med. 2005, 33 (2): 414-8. 10.1097/01.CCM.0000153410.87750.53.CrossRefPubMed
11.
Abella BS, Rhee JW, Huang KN, Vanden Hoek TL, Becker LB: Induced hypothermia is underused after resuscitation from cardiac arrest: a current practice survey. Resuscitation. 2005, 64 (2): 181-6. 10.1016/j.resuscitation.2004.09.014.CrossRefPubMed
12.
Merchant RM, Soar J, Skrifvars MB, Silfvast T, Edelson DP, Ahmad F, Huang KN, Khan M, Vanden Hoek TL, Becker LB, Abella BS: Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest. Crit Care Med. 2006, 34 (7): 1935-40. 10.1097/01.CCM.0000220494.90290.92.CrossRefPubMed
13.
Laver SR, Padkin A, Atalla A, Nolan JP: Therapeutic hypothermia after cardiac arrest: a survey of practice in intensive care units in the United Kingdom. Anaesthesia. 2006, 61 (9): 873-7. 10.1111/j.1365-2044.2006.04552.x.CrossRefPubMed
14.
Bigham BL, Dainty KN, Scales DC, Morrison LJ, Brooks SC: Predictors of adopting therapeutic hypothermia for post-cardiac arrest patients among Canadian emergency and critical care physicians. Resuscitation. 2010, 81 (1): 20-4. 10.1016/j.resuscitation.2009.09.022.CrossRefPubMed
15.
Kennedy J, Green RS, Stenstrom R: Hypothermic modulation of anoxic brain injury: a survey of Canadian emergency physicians. Scientific Abstracts CJEM. 2007, 9 (3): 203-
16.
Davis DP, Fisher R, Aguilar S, Metz M, Ochs G, McCallum-Brown L, Ramanujam P, Buono C, Vilke GM, Chan TC, Dunford JV: The feasibility of a regional cardiac arrest receiving system. Resuscitation. 2007, 74 (1): 44-51. 10.1016/j.resuscitation.2006.11.009.CrossRefPubMed
17.
Newgard CD, Sears GK, Rea TD, Davis DP, Pirrallo RG, Callaway CW, Atkins DL, Stiell IG, Christenson J, Minei JP, Williams CR, Morrison LJ, Investigators ROC: The Resuscitation Outcomes Consortium Epistry-Trauma: design, development, and implementation of a North American epidemiologic pre-hospital trauma registry. Resuscitation. 2008, 78 (2): 170-8. 10.1016/j.resuscitation.2008.01.029.CrossRefPubMedPubMedCentral
18.
Hussey MA, Hughes JP: Design and analysis of stepped wedge cluster randomized trials. Contemp Clin Trials. 2007, 28 (2): 182-91. 10.1016/j.cct.2006.05.007.CrossRefPubMed
19.
Scales DC, Dainty K, Hales B: An innovative telemedicine knowledge translation program to improve quality of care in intensive care units: protocol for a cluster randomized pragmatic trial. Implement Sci. 2009, 4: 5-10.1186/1748-5908-4-5.CrossRefPubMedPubMedCentral
20.
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR: Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999, 282 (15): 1458-65. 10.1001/jama.282.15.1458.CrossRefPubMed
21.
Morrison LJ, Nichol G, Rea TD, Christenson J, Callaway CW, Stephens S, Pirrallo RG, Atkins DL, Davis DP, Idris AH, Newgard C, Investigators ROC: Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Resuscitation. 2008, 78 (2): 161-9. 10.1016/j.resuscitation.2008.02.020.CrossRefPubMedPubMedCentral
22.
Idris AH, Becker LB, Ornato JP, Hedges JR, Bircher NG: Utstein-style guidelines for uniform reporting of laboratory CPR research. A statement for healthcare professionals from a Task Force of the American Heart Association, the American College of Emergency Physicians, the American College of Cardiology, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Institute of Critical Care Medicine, the Safar Center for Resuscitation Research, and the Society for Academic Emergency Medicine. Resuscitation. 1996, 33 (1): 69-84. 10.1016/S0300-9572(96)01055-6.CrossRefPubMed
23.
Duncan PW, Jorgensen HS, Wade DT: Outcome measures in acute stroke trials: a systematic review and some recommendations to improve practice. Stroke. 2000, 31: 1429-1438.CrossRefPubMed
24.
Safar P: Resuscitation after Brain Ischemia. Edited by: Grenvik A, Safar P. 1981, Brain Failure and Resuscitation, Churchill Livingstone, New York, 155-184.
25.
Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: time for a map?. J Contin Educ Health Prof. 2006, 26 (1): 13-24. 10.1002/chp.47.CrossRefPubMed
26.
Herlitz J, Engdahl J, Svensson L, Angquist KA, Silfverstolpe J, Holmberg S: Major differences in 1-month survival between hospitals in Sweden among initial survivors of out-of-hospital cardiac arrest. Resuscitation. 2006, 70 (3): 404-9. 10.1016/j.resuscitation.2006.01.014.CrossRefPubMed
27.
Sunde K, Pytte M, Jacobsen D, Mangschau A, Jensen LP, Smedsrud C, Draegni T, Steen PA: Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation. 2007, 73 (1): 29-39. 10.1016/j.resuscitation.2006.08.016.CrossRefPubMed
Metadata
Title
A knowledge translation collaborative to improve the use of therapeutic hypothermia in post-cardiac arrest patients: protocol for a stepped wedge randomized trial
Authors
Katie N Dainty
Damon C Scales
Steve C Brooks
Dale M Needham
Paul Dorian
Niall Ferguson
Gordon Rubenfeld
Randy Wax
Merrick Zwarenstein
Kevin Thorpe
Laurie J Morrison
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2011
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-6-4

Other articles of this Issue 1/2011

Implementation Science 1/2011 Go to the issue

Research article

Feasibility of a randomised trial of a continuing medical education program in shared decision-making on the use of antibiotics for acute respiratory infections in primary care: the DECISION+ pilot trial

Study protocol

Understanding implementation processes of clinical pathways and clinical practice guidelines in pediatric contexts: a study protocol

Research

The applicability of normalisation process theory to speech and language therapy: a review of qualitative research on a speech and language intervention

Study protocol

Rationale, design, and implementation protocol of the Dutch clinical practice guideline Pain in patients with cancer: a cluster randomised controlled trial with short message service (SMS) and interactive voice response (IVR)

Research

Reengineering the clinical research enterprise to involve more community clinicians

Study protocol

Evaluating the effectiveness of a tailored multifaceted performance feedback intervention to improve the quality of care: protocol for a cluster randomized trial in intensive care