Dr Paul Young

Specialist in Intensive Care Medicine, Wellington Hospital; Director, The Intensive Care Research Programme, Medical Research Institute of New Zealand, Wellington, NZ

Paul Young is an ICU Specialist at Wellington Hospital, New Zealand.  He is the Intensive Care Research Programme Director at the Medical Research Institute of New Zealand.  He is an active member of the ANZICS Clinical Trials Group.  Despite only seven years of research experience Dr Young has established himself as a highly recognised figure in the field of clinical ICU research internationally with more than 80 peer-reviewed publications.  He has more than $25M of current research funding and is involved in research collaborations with scientists from Australia, the UK, Canada, the USA, Italy, Scandinavia, and Brazil.  Paul is married and has three children (a 7 year old, a 9 year old, and an 11 year old).  He prefers kite surfing to working and you can track the progress of his clinical trials by following him on twitter @DogICUma.

Therapeutic Hypothermia for Out of Hospital Cardiac Arrest: Why Being Cool is So Hot Right Now 

The consequences of translation of new knowledge into practice are poorly understood and yet can have a major impact on patient treatment and outcomes.  

To evaluate knowledge translation into practice after publication of the Target Temperature Management (TTM) 33°C vs. 36°C After Out-of-hospital Cardiac Arrest (OHCA) trial and associated patient outcomes.  Our primary hypothesis was that TTM at 36°C was rapidly adopted in Australian and New Zealand (ANZ) ICUs.  Secondary hypotheses were that temporal reductions in mortality would be seen and would have accelerated after publication of the TTM trial.

We conducted a retrospective cohort study (January 2005 to December 2016) using the ANZICS-CORE adult patient database containing >2 million admission episodes from 186 ANZ ICUs.  16252 adults from 140 hospitals admitted to ICU after OHCA where included in this study comparing temperature management and outcomes before vs. after publication of the TTM trial.

The primary outcome variable to evaluate changes in temperature management was lowest temperature in the 1^st 24 hours in ICU.  The primary clinical outcome variable of interest was in-hospital mortality.  Secondary outcomes included proportion of patients with fever in the first 24 hours in ICU.  The mean±SD lowest temperature in the first 24 hours in ICU in pre- and post-TTM patients was 33.80±1.71°C and 34.70±1.39°C respectively (absolute difference 0.98°C [99%CI 0.89 to 1.06°C]; P<0.001).

In-hospital mortality rate decreased by 1.3 [99%CI -1.8 to -0.9] percentage points per year from January 2005 until December 2013 and increased by 0.6 [99%CI -1.4 to 2.6] percentage points per year from January 2014 until December 2016 (change in slope 1.9 percentage points per year [99%CI -0.6 to 4.4]; P=0.05).  Fever occurred in 568 of 4450 pre-TTM patients (12.8% [99%CI 11.5 to 14.1%]) and 853 of 5184 post-TTM patients (16.5% [99%CI, 15.2 to 17.8%]) (OR 1.35 [99%CI 1.16 to 1.57]; P<0.001).

After publication of the TTM trial clinicians have adopted higher temperature targets in OHCA patients.  This translation of new knowledge into practice was associated with an increased incidence of fever not seen in the TTM trial.  Further research is required to establish optimal temperature management for comatose OHCA patients.