Induced hypothermia by central venous infusion: Saline ice slurry versus chilled saline

Abstract

Cold intravenous fluids rapidly induce hypothermia in swine with intact circulation. A two-phase (liquid plus ice) saline slurry cools more rapidly than an equal volume of cold saline at 0 degrees C. Ice-slurry could be a significant improvement over other cooling methods when rate of cooling and limited infusion volumes are important to the clinician.

Intranasal Perfluorochemical Spray for Preferential Brain Cooling in Sheep

“…Prolonged maintenance (36 h) of mild hypothermia (34°C) by cardiopulmonary bypass following profound brain hypothermia (10-15°C) induced by aortic saline flush (i.e., 2°C; 20 l) supported intact neurological outcome in a dog model of cardiac arrest following prolonged hemorrhage [34]. In a recent advancement, Vanden Hoek et al demonstrated more rapid brain cooling using a two-phase, liquid plus ice, saline slurry than with an equal volume of cold saline [19]. Yet, all of these techniques necessarily invoke substantial systemic cooling along with brain cooling.…”

“…Cooling blood with intravenous catheters has gained interest because of its potential for long-term use [16,17]. Extracorporeal cooling strategies have been devised as simple veno-venous cooling or coolant infusion systems, or as sophisticated as carotid heat exchangers for independent control of brain and core temperatures [4,6,18,19]. While these approaches may be used in specialized hospitals for elective medical procedures, they have limited applicability for aiding in the recovery of neurological emergencies in the field.…”

Therapeutic Hypothermia in Cardiac Arrest Survivors

“…Infusion of 15 -30 ml/kg of 4 °C cold crystalloid (normal saline, Ringer solution, Hartmann solution) at an infusion rate >60 ml/h may induce the decrease of BT >1.4 °C (Kim et al, 2005;Kim et al, 2007;Kliegel et al, 2005;Kliegel et al, 2007;Virkkunen et al, 2004;Kämäräinen et al, 2008;Bernard & Rosalion, 2008;Bruel et al, 2008;Polderman et al, 2005;Vanden Hoek et al, 2004). However, additional cooling techniques are necessary for TH maintainance (Kliegel et al, 2007).…”

“…Animals experiments showed that early intra-arrest initiation of cooling resulted in significantly better neurological outcome than cooling after return of spontaneous circulation (Abella et al, 2004;Kuboyama et al, 1993). This concept was also evaluated in a few clinical studies.…”

Selective therapeutic hypothermia: A review of invasive and noninvasive techniques

“…Increased risk of infection, coagulopathy, cardiopulmonary compromise and risks of re-warming erode the clinical utility of systemic therapeutic hypothermia, offsetting any beneficial effects on neurological function and limiting the achievable depth of induced hypothermia 1,9 . Moreover, induction of systemic hypothermia exhibits a significant and unpredictable lag time from institution of therapy to achievement of target temperature 10 . Selective hypothermia, initially investigated in the 1960s prior to the advent of effective cardiopulmonary bypass, has re-emerged as a potential solution to the logistical obstacles and systemic complications of whole body hypothermia 11 .…”