Skip to main content

Earlier intra-arrest transnasal cooling may be beneficial

Introduction

Animal studies suggest a life-saving benefit for intra-arrest cooling. Transnasal evaporative cooling has sufficient heat transfer capacity for effective intra-arrest cooling and improves survival in swine. A 200-patient study showed transnasal cooling to be a safe and feasible method of intra-arrest cooling. The study also showed a solid trend to improved neurologically intact survival rates in those patients receiving intra-arrest transnasal cooling.

Methods

To determine effects on neurologically intact survival at 90 days from the addition of intra-arrest transnasal cooling compared with hospital-based cooling alone, patients in witnessed cardiac arrest of any rhythm and with CPR ≤15 minutes after a 112 call were randomized to intra-arrest transnasal cooling versus standard ACLS care in two European EMS systems. Transnasal cooling (RhinoChill (RC); BeneChill Inc., San Diego, CA, USA) was initiated using a mixture of volatile coolant plus oxygen for rapid evaporative heat transfer. In treatment patients, cooling was initiated pre-ROSC, during ongoing CPR. Patients in both groups were cooled upon hospital arrival.

Results

Forty-one patients have been included thus far. The median time from the 112 call for EMS to start CPR was 7 minutes and the time to initiate cooling was 17 minutes. ROSC was achieved in 8/19 (42%) of the RC group versus 8/22 (36%) of the control group. Site 1 initiated cooling at 11 minutes, and the ROSC rate at this site was 3/6 (50%) for RC and 1/9 (11%) for controls. EMS CPR was initiated at 5 minutes in RC versus 7 minutes in controls. Site 2 initiated cooling at 20 minutes, and the ROSC rate for this site was 5/13 (39%) for RC compared with 7/13 (54%) in the controls. EMS was initiated at 7 minutes in RC versus 9 minutes in controls.

Conclusions

Initiating transnasal cooling extremely early during arrest may be superior to later intra-arrest initiation in relation to ROSC rates. The impact of this ultra-early cooling on outcome remains to be determined.

Author information

Affiliations

Authors

Corresponding author

Correspondence to M Castren.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Castren, M., Nordberg, P., Taccone, F. et al. Earlier intra-arrest transnasal cooling may be beneficial. Crit Care 15, P303 (2011). https://doi.org/10.1186/cc9723

Download citation

Keywords

  • Heat Transfer
  • Evaporative Cool
  • Hospital Arrival
  • Sufficient Heat
  • Heat Transfer Capacity