Conclusions
The AHA guidelines for therapeutic hypothermia have
been rigorously developed and have the potential to
improve patient outcomes after cardiac arrest; however,
these guidelines may be underutilized in clinical practice.
We have summarized several theoretical frameworks
and general implementation approaches which allow us
to appreciate the underlying complexity of the phenomenon,
foresee potential barriers, and design effective
interventions.
Based on our analysis of barriers in therapeutic hypothermia,
interventions that are likely to have a positive impact
on guideline implementation will be increasing the visibility
of the therapeutic hypothermia guideline within the
AHA documents, adding a cooling protocol to the guideline,
using clinically embedded reminders, optimizing organizational
factors to facilitate therapeutic hypothermia delivery
and encouraging interprofessional involvement to promote
guideline implementation. Consideration of local contextual
factors should guide selection of these interventions
for maximum impact.
Specific therapeutic hypothermia implementation
research is desperately needed to guide future efforts.
Currently, the resuscitation community is limited to theory
and data derived from unrelated clinical problems
in trying to implement this clinically important therapy.
In the future, we need to measure and report our
theory-based implementation efforts to identify the most
successful implementation strategies for post-resuscitation
therapies.
Conflict of interest