Post Resuscitation Care: Level of Awareness on Therapeutic Hypothermia/targeted Temperature Monitoring Among Healthcare Providers in Nairobi, Kenya

Abstract

Patients who suffer cardiac arrest are susceptible to cerebral hypoxia and ischemia that leads to poor neurological outcomes in and out of hospital settings. Sudden cardiac arrest (SCA) is a leading cause of death in the USA and Canada [1]. Cardiac arrest patients’, who have return of spontaneous circulation (ROSC), may have poor functional outcomes as a result of hypoxic and ischemic insults sustained during and after the arrest period [2]. The neurological insults are largely dependent on the efficiency and quality of post resuscitation care offered by the health care providers [3]. For more than five decades now, the prognosis of sudden cardiac arrest has changed for the better in first world countries following the adoption of therapeutic hypothermia/ targeted temperature management (TH/TTM) during post resuscitation care. Locally, the situation is different. Critical Care Units (CCUs) at Kenyatta National and referral hospital (the largest public hospital in Kenya) has a mortality rate of 45% following cardiac arrest (KNH Monthly mortality minutes, 2010). Anecdotal evidence shows that TH/TTM has to some extent, been embraced locally, more so in the private hospitals following the adoption of recommendations from American Heart Association, ILCOR as well as the continuous professional development training programs offered, such as, Advanced Cardiac Life Support (ACLS). The investigator sought to find out the level of awareness on TH/TTM post cardiac arrest, among health care providers working in Kenya’s largest public referral hospital in Nairobi. Objective: To determine the level of awareness of therapeutic hypothermia/ TTM among healthcare providers at Kenyatta National Hospital’s (KNH), CCU. Methods: This was a cross sectional descriptive study conducted at the KNH’s 22 bed- Main CCU. Once ethical clearance was obtained, healthcare providers who worked in the CCU were purposively selected. A total of 54 participants consented to participation. Results: The investigator revealed that, a majority of the health care providers who participated in the study were critical care nurses (n=38, 71%). Most of the health care providers’ years of working experience in the CCU was between 1-5 years (n=23, 43%). A majority of the participants were aware of TH/TTM 35(65%) however the healthcare providers designation did not translate to awareness level of TH/TTM (p=0.211, 95%CI). All participants affirmed that TH/TTM was not being practiced in KNH-CCU, there was no protocol on TH/TTM and that there was need for it to be introduced in the hospital’s CCUs (p<0.001, 95%CI). The investigator concluded that, the participants were aware of TH/ TTM in the management of patients post cardiac arrest however this did not translate into clinical practice for all the healthcare providers in this study. The recommendations therefore are; strengthening the current level of awareness and practice through Continuous Professional Development (CPD) among health care providers on TH/ TTM and, development of TH/ TTM protocol at the institution for it’s availability and use can help in increasing the familiarity levels of TH/ TTM and optimize post resuscitation care in patients following cardiac arrest.