The Practice of Therapeutic Hypothermia after Cardiac Arrest in France: A National Survey Jean-Christophe Orban1,2*, Florian Cattet1, Jean-Yves Lefrant3, Marc Leone4, Samir Jaber5, Jean- Michel Constantin6, Bernard Allaouchiche7, Carole Ichai1,2 for the AzuRe´ a group 1 Re´animation me´dico-chirurgicale, Hoˆ pital Saint-Roch, Centre Hospitalier Universitaire de Nice, Nice, France, 2 IRCAN, Faculte´ de Me´decine, Universite´ de Nice, Nice, France, 3 Division Anesthe´sie Re´animation Douleur Urgences, Centre Hospitalier Universitaire de Nˆımes, Nˆımes, France, 4 Service anesthe´sie et re´animation, H oˆpital Nord, Marseille, France, 5 De´partement d’Anesthe´sie et de Re´animation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France, 6 Unite´ de Soins Intensifs, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France, 7 De´partement d’Anesthe´sie-Re´animation, H oˆpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France Abstract Aims: Cardiac arrest is a major health concern worldwide accounting for 375,000 cases per year in Europe with a survival rate of ,10%. Therapeutic hypothermia has been shown to improve patients’ neurological outcome and is recommended by scientific societies. Despite these guidelines, different surveys report a heterogeneous application of this treatment. The aim of the present study was to evaluate the clinical practice of therapeutic hypothermia in cardiac arrest patients. Methods: This self-declarative web based survey was proposed to all registered French adult intensive care units (ICUs) (n = 357). Paediatrics and neurosurgery ICUs were excluded. The different questions addressed the structure, the practical modalities of therapeutic hypothermia and the use of prognostic factors in patients admitted after cardiac arrest. Results: One hundred and thirty-two out of 357 ICUs (37%) answered the questionnaire. Adherence to recommendations regarding the targeted temperature and hypothermia duration were 98% and 94% respectively. Both guidelines were followed in 92% ICUs. During therapeutic hypothermia, sedative drugs were given in 99% ICUs, mostly midazolam (77%) and sufentanil (59%). Neuromuscular blocking agents (NMBA) were used in 97% ICUs, mainly cisatracurium (77%). Numerous prognostic factors were used after cardiac arrest such as clinical factors (95%), biomarkers (53%), electroencephalography (78%) and evoked potentials (35%). Conclusions: In France, adherence to recommendations for therapeutic hypothermia after cardiac arrest is higher than those previously reported in other countries. Numerous prognostic factors are widely used even if their reliability remains controversial. Citation: Orban J-C, Cattet F, Lefrant J-Y, Leone M, Jaber S, et al. (2012) The Practice of Therapeutic Hypothermia after Cardiac Arrest in France: A National Survey. PLoS ONE 7(9): e45284. doi:10.1371/journal.pone.0045284 Editor: Claudio Moretti, S.G.Battista Hospital, Italy Received June 5, 2012; Accepted August 14, 2012; Published September 25, 2012 Copyright: 2012 Orban et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: The authors have no support or funding to report. Competing Interests: The authors have declared that no competing interests exist. * E-mail: orban.jc@chu-nice.fr Introduction Cardiac arrest is a major health concern in industrialised countries accounting for 375000 cases per year in Europe with an overall survival ,10% [1,2,3]. Resuscitation is considered success- ful when patients exhibit a good neurological outcome (usually cerebral performance category 1 and 2 corresponding to good cerebral performance or moderate disability). Among numerous interventions assessed to improve neurological outcome, only therapeutic hypothermia obtained good results after cardiac arrest due to ventricular fibrillation [4,5]. In the study by Bernard et al., mild hypothermia at 33uC during 12 hours improved survival with a good outcome (adjusted odds ratio for good outcome: 5.25 [95% confidence interval 1.47 to 18.76]) [4]. In the HACA study, therapeutic hypothermia with a target temperature between 32 and 34uC during 24 hours showed comparable findings with a decreased mortality (risk ratio: 0.74 [95% confidence interval 0.58 to 0.95]) and a favourable neurologic outcome (risk ratio: 1.40 [95% confidence interval 1.08 to 1.81]) [5]. Further retrospective studies reported similar benefit when therapeutic hypothermia was applied in patients with cardiac arrest secondary to initial ventricular fibrillation [6,7,8]. Such findings were not reported in patients with initial asystole [8]. Based on these prospective studies, the European Resuscitation Council (ERC) published recommendations in 2005, updated in 2010, for the use of mild therapeutic hypothermia in unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest when the initial rhythm is ventricular fibrillation but also asystole [9]. The statement recommends duration of therapeutic hypothermia of 12 to 24 hours and a temperature between 32 and 34uC. Despite the high evidence of these recommendations, different surveys reported the application of therapeutic hypothermia in 13% to 61% [10–14]. As the application of therapeutic hypothermia after cardiac arrest has PLOS ONE | www.plosone.org 1 September 2012 | Volume 7 | Issue 9 | e45284