Summary The 2005 International Liaison Committee on Resuscitation (ILCOR) Consensus on
Science and Treatment Recommendations document represents the most extensive and rigorous
systematic review of the resuscitation literature to date and included evidence-based
recommendations for post-resuscitation care. A new recommendation for the induction of mild
therapeutic hypothermia for comatose cardiac arrest survivors was included in this document.
Accordingly, constituent national member associations of ILCOR, including the American Heart
Association, incorporated the recommendation for therapeutic hypothermia into their respective
guidelines. Despite these endorsements there is a concern that therapeutic hypothermia
is not being used in practice. Data from a number of surveys in Europe and the United States
suggest that rates of use among physicians may be as low as 30—40%. Despite the cost and
effort associated with the production of these guidelines and the potential impact on patient
care, current efforts in implementing the guideline have not achieved widespread success. This
commentary explores the issue of underutilization of the American Heart Association guidelines
for therapeutic hypothermia and looks to the knowledge translation literature to inform a new
approach to implementation. We will review the underlying phenomenon of research implementation
into practice, specific barriers to guideline implementation and interventions that
may improve therapeutic hypothermia uptake.