John Prior, D.O., and colleagues at Mercy Hospital in Scranton, Pa., suggest that small community hospitals can safely and effectively use cooling blankets/suits and ice bags at the groin, underarm, leg joints and neck to cool core temperatures of patients with ROSC after OOHCA. In their study, three community hospitals used this strategy to chill 44 resuscitated patients, aged 23 to 87 years old. On average, therapeutic hypothermia started within 2.8 hours of resuscitation. It took just more than seven hours to reach body temperature goals of 32° to 34° C (89.6° to 93.2° F); these temps were maintained for 24 hours. Overall, 43 percent of patients survived to hospital discharge with good neurological outcome. Among a similar group of non-cooled patients previously treated at the hospitals, just 13 percent similarly survived. — Southern Medical Journal 103(4):295–300, April 2010.
Stephen A. Bernard, M.D., and colleagues at Monash University in Melbourne and The Alfred Hospital in Prahran, Australia, compared outcomes of 118 adults therapeutically cooled in a prehospital setting by paramedics and 116 adults who underwent in-hospital therapeutic hypothermia. All patients had been resuscitated after OOHCA with an initial rhythm of ventricular fibrillation. Paramedic-initiated hypothermia (2 liters of ice-cold lactated Ringer’s infusion) lowered patients’ core body temperatures by 0.8° C on average before arrival at the hospital. But prehospital cooling did not improve outcome at hospital discharge more than in-hospital cooling: Overall, 47.5 percent of prehospital and 52.6 percent of in-hospital chilled patients were discharged either home or to a rehab facility. Bernard’s team suggests the prehospital CPR treatment protocol, which called for ambient-temperature IV fluids during CPR, may have minimized the effect from paramedic-delivered chilled IVs. They call for additional investigations that assess patient outcome after using ice-cold fluid infusion during the entire resuscitation process. — Circulation 122:737–742, August 2010.
Maaret Castren, M.D., Ph.D., at Karolinska Institute in Stockholm, and colleagues from Belgium, Germany, Italy and the Czech Republic assessed outcomes in 93 adult patients treated with intranasal cooling by ALS crews using a backpack device to deliver a coolant spray with oxygen via nasal catheter. These and 101 adults in a control group had witnessed OOHCA and advanced pre- and in-hospital life support, and received in-hospital full-body therapeutic hypothermia. Intranasally chilled patients reached core temperatures of 34° C in less than half the time of patients chilled only via standard in-hospital methods. However, ROSC was not significantly different in the intranasal group (35 patients) and control group (43 patients), nor was overall survival to discharge among patients admitted alive (44 and 31 percent) or neurologically intact survival to hospital discharge (34 and 21 percent) among pre- and in-hospital groups. — Circulation doi: 10.1161/CIRCULATIONAHA.109.931691, published online Aug. 2, 2010.
