Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room

Takeda, Yasuharu; Kondo, Takahisa; Kiyota, Kazuya; Oda, Shigeto; Morimoto, Naoki; Kobata, Hitoshi; Isobe, Hisashi; Honda, Masashi; Fujimi, Satoshi; Onda, Jun; Seishi, I; Sakamoto, Tetsuya; Ishikawa, Masami; Nakano, Hiroshi; Sadamitsu, Daikai; Kishikawa, Masanobu; Kinoshita, Kosaku; Yokoyama, Tomoharu; Harada, Masahiro; Kitaura, Michio; Ichihara, Kiyoshi; Hashimoto, Hiroshi; Tsuji, Hitomi; Yorifuji, Takashi; Nagano, Osamu; Katayama, Hiroshi; Ujike, Yoshihito; Morita, Kiyoshi

doi:10.1016/j.resuscitation.2014.09.014

Cited by 20 publications

(16 citation statements)

References 18 publications

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“…Takeda et al 17 posited this theory and established a pharyngeal cooling system to cool the brain by cooling the carotid artery. 9,17 As the lung has a very large area of alveoli, the efficacy of heat exchange may be better there than in other organs, working in the same way as an air cooling radiator. If the lungs can be cooled during CA when the blood flow is slow, the blood maybe cooled more efficiently.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6] This strategy, so-called intra-arrest therapeutic hypothermia (IATH), has been developed in clinical practice using many kinds of equipment to conduct transnasal evaporative cooling, 7 cold saline and external cooling, 8 and pharyngeal cooling. 9 Although all these types of equipment could be proven to induce IATH in the clinical setting, they were not able to improve the outcome of patients after CA. Moreover, the International Liaison Committee on Resuscitation recommended against routine use of prehospital cooling with rapid infusion of large volumes of cold IV fluid immediately after return of spontaneous circulation (ROSC).…”

Section: Introductionmentioning

confidence: 99%

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Development of new equipment for intra‐arrest brain cooling that uses cooled oxygen in the lungs: volunteer study

Sakurai

Tagami

Ihara

et al. 2016

Acute Medicine & Surgery

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Aims: Many experimental studies have reported that intra-arrest cooling during cardiac arrest is a promising treatment to mitigate brain injury. However, there is no clinically established method for cooling the brain during cardiac arrest. We hypothesized that, as blood flow in the lungs must be very slow during cardiopulmonary resuscitation, the blood could be cooled by ventilating the lungs with cooled oxygen like a radiator, and that this cooled blood would in turn cool the brain. The aim of this study was to develop equipment to cool oxygen for this purpose and to confirm its safety on a group of volunteers. Methods:We developed new equipment that cools oxygen by running it through a vinyl chloride coil submerged in a bottle of water and frozen at À80°C. Using this equipment, seven volunteers were given oxygen by mask, and their blood pressure, heart rate, and peripheral saturation of oxygen were measured. The temperature in the mask was also measured.Results: This equipment was able to decrease the temperature in the mask to À5°C at the Jackson Rees circuit for an oxygen flow of 10 L/min. Among the volunteer group, vital signs were unchanged and the temperature in the mask decreased from 30.1 AE 2.6°C (mean AE standard deviation) to 15.9 AE 9.6°C. No adverse effects were observed in the volunteers after experimentation. Conclusion:We successfully developed new equipment to cool oxygen and established its safety in a volunteer study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development of new equipment for intra‐arrest brain cooling that uses cooled oxygen in the lungs: volunteer study

Sakurai

Tagami

Ihara

et al. 2016

Acute Medicine & Surgery

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“…[ 95 ] Importantly, recent technological advances in the development of effective intravascular, surface, and other cooling approaches have reduced the delay in reaching hypothermia temperature targets. [ 96 97 98 99 ]…”

Section: Therapeutic Windowmentioning

confidence: 99%

Therapeutic hypothermia and targeted temperature management for traumatic brain injury: Experimental and clinical experience

Dietrich

Bramlett

2017

Brain Circ

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Traumatic brain injury (TBI) is a worldwide medical problem, and currently, there are few therapeutic interventions that can protect the brain and improve functional outcomes in patients. Over the last several decades, experimental studies have investigated the pathophysiology of TBI and tested various pharmacological treatment interventions targeting specific mechanisms of secondary damage. Although many preclinical treatment studies have been encouraging, there remains a lack of successful translation to the clinic and no therapeutic treatments have shown benefit in phase 3 multicenter trials. Therapeutic hypothermia and targeted temperature management protocols over the last several decades have demonstrated successful reduction of secondary injury mechanisms and, in some selective cases, improved outcomes in specific TBI patient populations. However, the benefits of therapeutic hypothermia have not been demonstrated in multicenter randomized trials to significantly improve neurological outcomes. Although the exact reasons underlying the inability to translate therapeutic hypothermia into a larger clinical population are unknown, this failure may reflect the suboptimal use of this potentially powerful therapeutic in potentially treatable severe trauma patients. It is known that multiple factors including patient recruitment, clinical treatment variables, and cooling methodologies are all important in yielding beneficial effects. High-quality multicenter randomized controlled trials that incorporate these factors are required to maximize the benefits of this experimental therapy. This article therefore summarizes several factors that are important in enhancing the beneficial effects of therapeutic hypothermia in TBI. The current failures of hypothermic TBI clinical trials in terms of clinical protocol design, patient section, and other considerations are discussed and future directions are emphasized.

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“…11,12 Researchers hypothesized that mild hypothermia after stroke could reduce the neurological damage and delay brain death. 13 Therefore, hypothermia was accepted as an effective intervention for reducing ICP in patients with traumatic brain injury. 14,15 Other empirical studies supported the neurological effects of hypothermia.…”

Section: Introductionmentioning

confidence: 99%

Impact of Mild Hypothermia on Final Outcome of Patients with Acute Stroke: A Randomized Clinical Trial

Rouzbahani

Khodadadi

Fooladi³

2020

Indian Journal of Neurotrauma

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Background and Aim Stroke is a sudden neurological disorder caused by disturbances in the brain blood flow and loss of normal brain function. Stroke is also the second leading cause of death worldwide. In the last two decades, among the various treatment options for stroke, hypothermia has shown the promise of improving the final outcome. This study aimed to investigate the effect of noninvasive hypothermia on the final outcome of patients with an acute stroke in Iran. Methods In a randomized clinical trial, 60 Iranian patients diagnosed with acute stroke were enrolled in 2018. Patients were selected by convenience sampling method and then randomized in two groups as experimental (n = 30) and control (n = 30). Mild hypothermia was applied using a cooling device for 72 hours on the patients’ heads and intervention results were compared with the control group. Data were collected by using Acute Physiology and Chronic Health Evaluation III (APACHE III), Full Outline of Un-Responsiveness (FOUR), and National Institutes of Health Stroke Scale (NIHSS), and later analyzed by Statistical Package for the Social Sciences (SPSS) software version 22. Results No significant difference was found in the mean scores of all three scales before and after the intervention in control group (p > 0.05) but statistically significant difference was found in the mean scores of all three scales for the intervention group (p < 0.05). The intervention group had an increased mean score in FOUR, while APACHE and NIHSS values dropped. Researchers found statistically significant difference between the mean scores after the intervention in the experimental group compared with the control group in all three scales (p < 0.05). Conclusion The findings of this study indicate that hypothermia has a significant statistical and clinical effect on the acute stroke outcome and it can be argued that hypothermia therapy can increase the level of consciousness and reduce the risk of death in stroke patients.

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Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room

Abstract: Initiation of pharyngeal cooling before or immediately after the return of spontaneous circulation is safe and feasible. Pharyngeal cooling can rapidly decrease tympanic temperature without adverse effects on circulation or the pharyngeal epithelium.

Cited by 20 publications

References 18 publications

Development of new equipment for intra‐arrest brain cooling that uses cooled oxygen in the lungs: volunteer study

Development of new equipment for intra‐arrest brain cooling that uses cooled oxygen in the lungs: volunteer study

Therapeutic hypothermia and targeted temperature management for traumatic brain injury: Experimental and clinical experience

Impact of Mild Hypothermia on Final Outcome of Patients with Acute Stroke: A Randomized Clinical Trial

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