Document Detail


Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness).
MedLine Citation:
PMID:  20679548     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 <or=20 minutes were randomized to intra-arrest cooling with a RhinoChill device (treatment group, n=96) versus standard care (control group, n=104). 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 degrees C was shorter in the treatment group for both tympanic (102 versus 282 minutes, P=0.03) and core (155 versus 284 minutes, P=0.13) 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, P=0.48), in overall survival of those admitted alive (44% versus 31%, respectively, P=0.26), or in neurologically intact survival to discharge (Pittsburgh cerebral performance category scale 1 to 2, 34% versus 21%, P=0.21), although the study was not adequately powered to detect changes in these outcomes. CONCLUSIONS: Prehospital intra-arrest transnasal cooling is safe and feasible and is associated with a significant improvement in the time intervals required to cool patients.
Authors:
Maaret Castrén; Per Nordberg; Leif Svensson; Fabio Taccone; Jean-Louise Vincent; Didier Desruelles; Frank Eichwede; Pierre Mols; Tilmann Schwab; Michel Vergnion; Christian Storm; Antonio Pesenti; Jan Pachl; Fabien Guérisse; Thomas Elste; Markus Roessler; Harald Fritz; Pieterjan Durnez; Hans-Jörg Busch; Becky Inderbitzen; Denise Barbut
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-08-02
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-17     Completed Date:  2010-09-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  729-36     Citation Subset:  AIM; IM    
Affiliation:
Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00808236
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MeSH Terms
Descriptor/Qualifier:
Administration, Intranasal
Aged
Body Temperature / physiology
Cold Temperature
Emergency Medical Services / methods*
Female
Heart Arrest / physiopathology,  therapy*
Humans
Hypothermia, Induced / instrumentation*,  methods*
Male
Middle Aged
Prospective Studies
Time Factors
Comments/Corrections
Comment In:
Circulation. 2010 Aug 17;122(7):679-81   [PMID:  20679546 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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