Intra-Arrest Transnasal Evaporative Cooling

Abstract

Background-Transnasal evaporative cooling has sufficient heat transfer capacity for effective intra-arrest cooling and improves survival in swine. The aim of this study was to determine the safety, feasibility, and cooling efficacy of prehospital transnasal cooling in humans and to explore its effects on neurologically intact survival to hospital discharge. Methods and Results-Witnessed cardiac arrest patients with a treatment interval Յ20 minutes were randomized to intra-arrest cooling with a RhinoChill device (treatment group, nϭ96) versus standard care (control group, nϭ104). The final analysis included 93 versus 101 patients, respectively. Both groups were cooled after hospital arrival. The patients had similar demographics, initial rhythms, rates of bystander cardiopulmonary resuscitation, and intervals to cardiopulmonary resuscitation and arrival of advanced life support personnel. Eighteen device-related adverse events (1 periorbital emphysema, 3 epistaxis, 1 perioral bleed, and 13 nasal discolorations) were reported. Time to target temperature of 34°C was shorter in the treatment group for both tympanic (102 versus 282 minutes, Pϭ0.03) and core (155 versus 284 minutes, Pϭ0.13) temperature. There were no significant differences in rates of return of spontaneous circulation between the groups (38% in treated subjects versus 43% in control subjects, Pϭ0.48), in overall survival of those admitted alive (44% versus 31%, respectively, Pϭ0.26), or in neurologically intact survival to discharge (Pittsburgh cerebral performance category scale 1 to 2, 34% versus 21%, Pϭ0.21), although the study was not adequately powered to detect changes in these outcomes. Conclusions-Prehospital

The therapeutic hypothermia after resuscitated cardiac arrest caused by ventricular fibrillation: a retrospective study in Saint Pierre University Hospital

“…Animal models demonstrate that, earliest the hypothermia is initiated, the most beneficial effect is on neurological outcome. In human models, there are conflicting results: it seems that hypothermia remains beneficial even if delayed [16,17] . Therefore, there are still ongoing investigations to evaluate the effect of the delay of initiation of hypothermia in CA management.…”

The impact of prehospital resuscitation research on in-hospital care

“…[51][52][53] Directly or indirectly, this led to an increased emphasis on EMS initiation of cooling in the field immediately following ROSC. 54,55 Recently, the conversation around the optimal use of therapeutic hypothermia has intensified with two large randomized trials failing to show a survival advantage for cooled patients. Nielsen et al examined the influence of cooling post-arrest patients to 36°C (96.8°F) instead of 33°C (91.4°F) and noted that survival was similar between groups.…”

From Door to Recovery: A Collaborative Approach to the Development of a Post–Cardiac Arrest Center

“…In 2002, 2 key studies 25,26 showed that treatment with 27 and the AHA 28 recommended induced hypothermia in post-cardiac arrest patients with ROSC who remain comatose ( Table 2). Prehospital cooling studies 29,30 have also been performed; however, no clear evidence shows that prehospital cooling is advantageous, and ongoing investigations continue. Induced hypothermia should be initiated to a target temperature of 32ºC to 34ºC as quickly as possible and within 6 to 12 hours for patients who are unable to follow verbal commands after ROSC.…”