Opinions and attitudes toward targeted temperature management in the emergency department and intensive care unit in a developing country: a survey study

doi:10.5847/wjem.j.1920-8642.2023.030

Abstract

Abdullah Bakhsh, Hadeel Alotaibi, Sara Alothman, Abdulrahman Alothman, Rahaf Alothman, Abdulrahman Alsulami, Malak Alamoudi, Ali Alothman, Ali Al-Shareef. Opinions and attitudes toward targeted temperature management in the emergency department and intensive care unit in a developing country: a survey study[J]. World Journal of Emergency Medicine, 2023, 14(2): 138-142.

Figures/Tables 3

Table 1.

Table 2.

Participants’ personal practice and opinions (n=167)

Personal practice	Value	Personal practice	Value
Opinion on TTM		21 h	35 (21.0%)
Believes it improves	143 (85.6%)	36 h	20 (12.0%)
Did not believe it improves	24 (14.4%)	48 h	42 (25.1%)
Number of cardiac arrest per month		72 h	11 (6.6%)
Less than 5 per month	81 (48.5%)	Others	22 (13.2%)
5-10 per month	58 (34.7%)	Minimum mean arterial pressure required during TTM
10-20 per month	16 (9.6%)	>55 mmHg	9 (5.4%)
More than 20 per month	7 (4.2%)	>60 mmHg	44 (26.3%)
I do not know	5 (3.0%)	>65 mmHg	93 (55.7%)
Selection criteria for TTM in post-cardiac arrest patients		>70 mmHg	10 (6.0%)
In-hospital cardiac arrest	120 (71.9%)	>75 mmHg	7 (4.2%)
Shockable rhythms	87 (52.1%)	Others	4 (2.4%)
Comatose patients	68 (40.7%)	Best method for temperature measurement
Implementation within 6 h	63 (37.7%)	Rectal	58 (34.7%)
Systolic blood pressure more than 90 mmHg	53 (31.7%)	Axillary	38 (22.8%)
Out-of-hospital cardiac arrest	60 (35.9%)	Esophageal	44 (26.3%)
Non-shockable rhythms	39 (23.4%)	Tympanic membrane	18 (10.8%)
Others	10 (6.0%)	Others	5 (3.0%)
Exclusion criteria for TTM		Bladder	4 (2.4%)
Do-not-resuscitate order	102 (61.1%)	Preferred sedative/analgesic
Coagulopathy	90 (53.9%)	Fentanyl	36 (21.6%)
Dysrhythmia	41 (24.6%)	Midazolam	37 (22.2%)
Systolic blood pressure less than 90 mmHg	32 (19.2%)	Propofol	36 (21.6%)
Mean arterial pressure less than 65 mmHg	31 (18.6%)	Lorazepam	5 (3.0%)
Others	30 (18.0%)	Others	13 (7.8%)
Methods to induce TTM		Not applicable	40 (24.0%)
External cooling blanket	59 (35.3%)	Routine use of neuromuscular blocking agent
Cold saline infusion (4 °C)	49 (29.3%)	No	109 (66.1%)
Ice packs in groin and armpits	33 (19.8%)	Yes	38 (23.0%)
Internal cooling device	12 (7.2%)	Not applicable	18 (10.9%)
Antipyretics	10 (6.0%)	Routine use of preventive anti-epileptic agents
Others	4 (2.4%)	No	113 (67.7%)
Preferred routine target temperature during treatment		Yes	42 (25.1%)
32 °C	15 (9.0%)	Not applicable	12 (7.2%)
33 °C	13 (7.8%)	Methods to determine neurologic prognosis
34 °C	55 (32.9%)	Neurophysiology studies	60 (35.9%)
35 °C	21 (12.6%)	EEG	56 (33.5%)
36 °C	58 (34.7%)	Others	25 (15.0%)
Others	5 (3.0%)	Not applicable	20 (12.0%)
Opinion on duration of TTM treatment		Biomarkers	6 (3.6%)
12 h	37 (22.2%)

Table 2.

Table 3.

References 25

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[9]	Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullén S, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med. 2021; 384(24): 2283-94. doi: 10.1056/NEJMoa2100591
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Characteristics	Value
Specialty
Emergency medicine	109 (65.3%)
Critical care medicine	44 (26.3%)
Anesthesia	7 (4.2%)
Double board certified in emergency medicine and critical care medicine	7 (4.2%)
Current position
Registered nurse	50 (29.9%)
Consultant physician	79 (47.3%)
Resident physician (trainee)	38 (22.8%)
Hospital
Academic (university)	78 (46.7%)
Non-academic (government)	57 (34.1%)
Private sector	32 (19.2%)
Primary work location
Jeddah	119 (71.3%)
Riyadh	21 (12.6%)
Bahrain	11 (6.6%)
Makkah	5 (3.0%)
Dammam/Khobar	9 (5.4%)
Certified in Advanced Cardiac Life Support (ACLS) or Fundamentals of Critical Care Support (FCCS)
Yes	151 (90.4%)
No	16 (9.6%)

Institutional practice	Value
Available TTM protocol within the department
Yes	109 (65.3%)
No	58 (34.7%)
TTM is standard of care within the department
Yes	90 (53.9%)
No	77 (46.1%)
Participant perceived barriers for implementation of TTM
No established protocol	87 (52.1%)
Lack of necessary equipment	61 (36.5%)
Lack of expert persons	53 (31.7%)
Lack of resources/funding	41 (24.6%)
Low number of cardiac arrest patients	33 (19.8%)
Not enough scientific evidence	38 (22.8%)
Treatment is futile as prognosis is poor	19 (11.4%)
Technically too difficult to implement	21 (12.6%)
Others	30 (18.0%)

Opinions and attitudes toward targeted temperature management in the emergency department and intensive care unit in a developing country: a survey study

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