Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital Cardiac Arrest

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Abstract

Therapeutic hypothermia may increase survival with good neurologic outcome after cardiac arrest. Trans-nasal evaporative cooling is a method used to induce cooling, primarily of the brain, during cardiopulmonary resuscitation (ie, intra-arrest).

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Most cited references 13

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ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical Scale

B Jennett (1975)

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Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness).

Henrik Nordberg, Christian Storm, Hans-Jörg Busch … (2010)

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. Witnessed cardiac arrest patients with a treatment interval

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Intra-arrest cooling improves outcomes in a murine cardiac arrest model.

Benjamin S Abella, Danhong Zhao, Jason Alvarado … (2004)

Recent clinical studies have demonstrated that hypothermia to 32 degrees to 34 degrees C provides significant clinical benefit when induced after resuscitation from cardiac arrest. However, cooling during the postresuscitation period was slow, requiring 4 to 8 hours to achieve target temperatures after return of spontaneous circulation (ROSC). Whether more rapid cooling would further improve survival remains unclear. We sought to determine whether cooling during cardiac arrest before ROSC (ie, "intra-arrest" hypothermia) has survival benefit over more delayed post-ROSC cooling, using a murine cardiac arrest model. A model of potassium-induced cardiac arrest was established in C57BL/6 mice. After 8 minutes of untreated cardiac arrest, resuscitation was attempted with chest compression, ventilation, and intravenous fluid. Mice were randomized to 3 treatment groups (n=10 each): an intra-arrest hypothermia group, in which mice were cooled to 30 degrees C just before attempted resuscitation, and then rewarmed after 1 hour; a post-ROSC hypothermia group, in which mice were kept at 37 degrees C for 20 minutes after successful ROSC and then were cooled to 30 degrees C for 1 hour; and a normothermic control group, in which mice were kept at 37 degrees C. The intra-arrest hypothermia group demonstrated better 72-hour survival than delayed hypothermia and normothermia groups (6/10 versus 1/10 and 1/10 survivors, respectively, P<0.05), with similar differences seen at 6-hour survival and on neurological scoring. Timing of hypothermia is a crucial determinant of survival in the murine arrest model. Early intra-arrest cooling appears to be significantly better than delayed post-ROSC cooling or normothermic resuscitation.

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Author and article information

Journal

Title: JAMA

Abbreviated Title: JAMA

Publisher: American Medical Association (AMA)

ISSN (Print): 0098-7484

Publication date Created: May 07 2019

Publication date (Print): May 07 2019

Volume: 321

Issue: 17

Page: 1677

Affiliations

[1 ]Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden

[2 ]Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium

[3 ]Emergency Medical Services of the Hradec Kralove Region, Czech Republic

[4 ]Department of Anesthesiology and Intensive Care, Norrtälje Hospital, Norrtälje, Sweden

[5 ]Emergency Department and SAMU, Centre Hospitalier Régional Universitaire de Lille, Lille, France

[6 ]Emergency Department, St Maria Hospital, Halle, Belgium

[7 ]Sistema d'Emergències Mèdiques, Barcelona, Catalunya, Spain

[8 ]Empresa Pública de Emergencias Sanitarias, Almería, Andalucía, Spain

[9 ]School of Health and Social Work, University of Hertfordshire, Hertfordshire, United Kingdom

[10 ]Emergency Department, University Hospitals of Leuven, Leuven, Belgium

[11 ]Department of Emergency Medicine, University Hospital of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

[12 ]Department of Physiology and Pharmacology, Karolinska Institute, and Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden

Article

DOI: 10.1001/jama.2019.4149

PMC ID: 6506882

PubMed ID: 31063573

SO-VID: d0419f62-a969-4dd9-9685-1d4338ffdc5c

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