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  • Poster presentation
  • Open Access

Earlier intra-arrest transnasal cooling may be beneficial

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Critical Care201115 (Suppl 1) :P303

  • Published:


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


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.


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.


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.


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.

Authors’ Affiliations

Karolinska Institutet, Stockholm, Sweden
Södersjukhuset, Stockholm, Sweden
Erasme Hospital, Brussels, Belgium
BeneChill, Inc., San Diego, CA, USA


© Castren et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.