References

Abella B, Rhee J, Huang K Induced hypothermia is underused after resuscitation from cardiac arrest: a current practice survey. Resuscitation. 2005; 64:(2)181-6

Annopoulos D, Kotsifas K, Aufderheide T Cardiac arrest, mild therapeutic hypothermia, and unanticipated cerebral recovery. Neurologist. 2007; 13:(6)369-75

Arrich J Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med. 2007; 35:(4)1041-7

Bayegan K, Janata A, Frossard M Rapid non-invasive external cooling to induce mild therapeutic hypothermia in adult human-sized swine. Resuscitation. 2008; 76:(2)291-8

Bernard S, Gray T, Buist M Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; 346:(8)557-63

Bernard S Therapeutic hypothermia after cardiac arrest: now a standard of care. Crit Care Med. 2006; 34:(3)923-924

Boddicker K, Zhang Y, Zimmerman M Hypothermia improves defibrillation success and resuscitation outcomes from ventricular fibrillation. Circulation. 2005; 111:(24)3195-3201

Boller M, Lampe J, Becker L Feasibility of selective brain cooling during cardiac arrest: a novel nasopharyngeal approach.. Circulation. 2007; 116

Busch H, Eichwede F, Födisch M Safety and feasibility of nasopharyngeal evaporative cooling in the emergency department setting in survivors of cardiac arrest. Resuscitation. 2010; 81:(8)943-9

Castren M, Norberg P, Svensson L Intra-arrest trans-nasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Circulation. 2010; 122:(7)729-36

Department of Health. http//tinyurl.com/2a8ljeo

Hachimi-Idrissi S, Corne L, Ebinger G Mild hypothermia induced by a helmet device: a clinical feasibility study. Resuscitation. 2001; 51:(3)275-81

Hoedmaekers C, Ezzahti M, Gerritsen A Comparison of cooling methods to induce and maintain normo-and hypothermia in intensive care unit patients: a prospective intervention study.. Critical Care. 2007; 11:(4)

Holzer M The hypothermia after cardiac arrest study group: mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002; 346:(8)549-56

Holzer M, Bernard S, Hachimi-Idrissi S Collaborative Group on Induced Hypothermia for Neuroprotection After Cardiac Arrest. Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis. Crit Care Med. 2005; 33:(2)414-18

Holzer M, Behringer W, Janata A Extracorporeal venovenous cooling for induction of mild hypothermia in humansized swine. Crit Care Med. 2005; 33:(6)1346-50

Holzer M Devices for rapid induction of hypothermia. . European Journal of Anaesthesiology. 2008; 25:(Suppl 42)31-38

Kliegel A, Losert H, Sterz F Cold simple intravenous infusions preceding special endovascular cooling for faster induction of mild hypothermia after cardiac arrest—a feasibility study. Resuscitation. 2005; 64:(3)347-51

Kupchick L Development and Implementation of a therapeutic hypothermia protocol.. Crit Care Med. 2009; 37:(7 Suppl)S279-84

Merchant R, Soar J, Skrifvars M Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest. Crit Care Med. 2006; 34:(7)1935-40

Nielsen N, Hovdenes J, Nilsson F Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest. Acta Anaesthesiol Scand. 2009; 53:(7)926-34

Nolan J, Morley P, Vanden Hoek T Therapeutic hypothermia after cardiac arrest: an advisory statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation. Circulation. 2003; 108:(1)118-21

Nolan J, Soar J, Zideman D European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation. 2010; 81:(10)1219-76

Oddo M, Schaller M, Feihl F From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med. 2006; 34:(7)1865-73

Polderman K, Herold I Therapeutic hypothermia and controlled normothermia in the intensive care unit: Practical cardiopulmonary resuscitation improves outcome after prolonged cardiac arrest in dogs. Crit Care Med. 2009; 19:(3)379-89

Sterz F, Safar P, Tisherman S Mild hypothermic considerations, side effects, and cooling methods. Crit Care Med. 1991; 37:(3)1101-20

Varon J, Acosta P Therapeutic Hypothermia, Past Present and Future. Chest. 2008; 133:(5)1267-74

Wolfson M, Malone D, Wu J Intranasal perfluorochemical spray for preferential brain cooling in sheep.. Neurocrit Care. 2008; 8:(3)437-47

Yu T, Barbut D, Ristagno G Survival and neurological outcomes after nasopharyngeal cooling or peripheral vein cold saline infusion initiated during cardiopulmonary resuscitation in a porcine model of prolonged cardiac arrest. Crit Care Med. 2010; 38:(3)916-21

A review of the pre-ROSC intranasal cooling effectiveness study

03 June 2011
Features
02 June 2011
Volume 3 · Issue 6

Abstract

With the publication of the 2010 European Resuscitation Council Guidelines, therapeutic hypothermia has been recommended as part of the treatment algorhythm for the management of adult cardiac arrest. As ambulance services around the world struggle to decide on the best method of cooling a patient at the time of the return of spontaneous circulation (ROSC), the ground-breaking ‘PRINCE’ study has been published describing the novel approach of ‘trans-nasal’ evaporative cooling during the peri-arrest period. This study describes a significant difference found on arrival at hospital between the mean tympanic temperatures of the two groups (cooled vs control) following a period of cooling (34.2 °C [SD 1.5 °C] vs 35.5 °C [SD 0.9 °C], P<0.001). In addition, when looking at survival to discharge following out-of-hospital (OOH) cardiac arrest, there was a statistically significant difference in a subgroup of patients where CPR was commenced within 10 minutes of cardiac arrest (56.5% of trans-nasally cooled patients survived to discharge compared with 29.4% of control patients (P=0.04, relative risk =1.9)). This article examines the PRINCE study and considers the implication of this method of inducing therapeutic hypothermia in the out-of-hospital cardiac arrest patient within the UK.

Guidelines for ambulance services and prehospital care are continuously under review. Now that our profession is embracing evidence-based practice, we as practitioners on the road find that what we do and how we do it are constantly under scrutiny and frequently changes as a result of new findings.

The Coalition Government has introduced new means for assessing the quality and performance of all ambulance trusts (Department of Health (DH, 2010). In April 2011, the ‘Category B’ target was to be replaced with a collection of clinical indicators and outcome measures that will, for the first time, attempt to look at the actual ‘care’ delivered to our patients in a very real way.

These new outcome measures are forcing ambulance trusts to look at maximizing the impact that the services provided have on their local populations and the local health economy, rather than just how fast an ambulance or response vehicle with a qualified member of staff can arrive at a patient's door.

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Advanced Life Support (ALS)
Cardiac arrest
Therapeutic hypothermia
Trans-nasal evaporative cooling