Out-of-hospital surface cooling to induce mild hypothermia in human cardiac arrest: A feasibility trial

Uray, Thomas; Malzer, Reinhard

doi:10.1016/j.resuscitation.2008.01.005

Cited by 81 publications

(46 citation statements)

References 39 publications

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“…12 Three studies proved the feasibility of immediate induction of hypothermia in the out-of-hospital setting, either by rapid infusion of approximately 2,000 mL of cold (4°C) crystalloids 19,20 or by surface cooling. 13 In one study, cooling by rapid infusion of cold crystalloids was started during chest compressions. 21 Additional prospective randomized controlled trials are needed to determine the importance of early induction of hypothermia to improved neurologic outcomes from cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

“…In the out-of-hospital setting, this cooling pad was applied within 12 minutes after successful resuscitation, and mild hypothermia of 33°C was achieved within 90 minutes. 13 For future use in the out-of-hospital setting as well as in-hospital setting, the volume, weight, and storage temperature of the cooling pad are of crucial importance. The aim of this study was to evaluate in-hospital cooling performance and possible adverse effects of a cooling pad design, which was modified twice in terms of storage temperature, size, and weight, in patients resuscitated from cardiac arrest.…”

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confidence: 99%

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Surface Cooling for Rapid Induction of Mild Hypothermia After Cardiac Arrest: Design Determines Efficacy

Uray

Haugk

Sterz

et al. 2010

Academic Emergency Medicine

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Objectives: Recently, a novel cooling pad was developed for rapid induction of mild hypothermia after cardiac arrest. The aim of this study was to evaluate the cooling efficacy of three different pad designs for in-hospital cooling.Methods: Included in this prospective interventional study were patients with esophageal temperature (Tes) > 34°C on admission. The cooling pad consists of multiple cooling units, filled with a combination of graphite and water, which is precooled to -18°C (design A) or to -9°C (designs B and C) before use. The designs of the cooling pad differed in number, shape, and thickness of the cooling units, with weights of 9.7 kg (design A), 5.3 kg (design B), and 6.2 kg (design C). All three designs were tested in sequential order and were changed according to the results found in the previous trial. Cooling was started after admission until Tes = 34°C, when the cooling pad was removed. The target temperature of Tes = 32-34°C was maintained for 24 hours. Data are presented as medians and interquartile ranges (IQRs = 25%-75%) or proportions.Results: Cooling rates were 3.4°C ⁄ hour (IQR = 2.5-3.7) with design A (n = 12), 2.8°C ⁄ hour (IQR = 1.6-3.3) with design B (n = 7), and 2.9°C ⁄ hour (IQR = 1.9-3.6) with design C (n = 10; p = 0.5). To reach 34°C, the cooling pad had to be exchanged with a new one due to melting and therefore depleting cooling capacity in three patients with design A, in five patients with design B, and in no patient with design C (p = 0.004). Conclusions:With adequate design and storage temperature, the cooling pad proved to be efficient for rapid in-hospital cooling of patients resuscitated from cardiac arrest.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Surface Cooling for Rapid Induction of Mild Hypothermia After Cardiac Arrest: Design Determines Efficacy

Uray

Haugk

Sterz

et al. 2010

Academic Emergency Medicine

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“…One example is the Emcools Pad System (Emcools, Vienna, Austria), which consists of pre-cooled hydrogel pads. Uray and Malzer [77] studied the feasibility of these pads for out-ofhospital surface cooling in 15 patients, initiated at an average of 12 minutes after return of spontaneous circulation. Target temperature of 33°C was achieved within an average of 50 minutes.…”

Section: Surface Coolingmentioning

confidence: 99%

Therapeutic Hypothermia for Acute Neurological Injuries

2012

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Therapeutic hypothermia (TH) is the intentional reduction of core body temperature to 32°C to 35°C, and is increasingly applied by intensivists for a variety of acute neurological injuries to achieve neuroprotection and reduction of elevated intracranial pressure. TH improves outcomes in comatose patients after a cardiac arrest with a shockable rhythm, but other off-label applications exist and are likely to increase in the future. This comprehensive review summarizes the physiology and cellular mechanism of action of TH, as well as different means of TH induction and maintenance with potential side effects. Indications of TH are critically reviewed by disease entity, as reported in the most recent literature, and evidence-based recommendations are provided.

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“…Letztendlich könnte der Nutzen am größten sein, wenn bereits während des Kreislaufstillstands mit der Kühlung begonnen wird; Labordaten deuten darauf hin, dass dies den ROSC sogar erleichtert [754,755]. Verschiedene klinische Studien konnten zeigen, dass die Hypothermie präkli-nisch eingeleitet werden kann [511, 729,730,732,741], allerdings gibt es bis bisher keine klinischen Daten, die belegen, dass ein rasches Erreichen der Zieltemperatur zu einem besseren Outcome führt. In einer registerbasierten Fallserie mit 986 komatösen Patienten nach Kreislaufstill-stand war der Zeitpunkt des Kühlungs-beginns nicht mit einem besseren neurologischen Outcome nach Krankenhausentlassung assoziiert [666].…”

Section: Temperaturkontrolleunclassified