Prehospital therapeutic hypothermia for comatose survivors of cardiac arrest: a randomized controlled trial.

BACKGROUND: Intravenous infusion of ice-cold fluid is considered a feasible method to induce mild therapeutic hypothermia in cardiac arrest survivors. However, only one randomized controlled trial evaluating this treatment exists. Furthermore, the implementation rate of prehospital cooling is low. The aim of this study was to evaluate the efficacy and safety of this method in comparison with conventional therapy with spontaneous cooling often observed in prehospital patients.

METHODS: A randomized controlled trial was conducted in a physician-staffed helicopter emergency medical service. After successful initial resuscitation, patients were randomized to receive either +4 degrees C Ringer's solution with a target temperature of 33 degrees C or conventional fluid therapy. As an endpoint, nasopharyngeal temperature was recorded at the time of hospital admission.

RESULTS: Out of 44 screened patients, 19 were analysed in the treatment group and 18 in the control group. The two groups were comparable in terms of baseline characteristics. The core temperature was markedly lower in the hypothermia group at the time of hospital admission (34.1+/-0.9 degrees C vs. 35.2+/-0.8 degrees C, P<0.001) after a comparable duration of transportation. Otherwise, there were no significant differences between the groups regarding safety or secondary outcome measures such as neurological outcome and mortality.

CONCLUSION: Spontaneous cooling alone is insufficient to induce therapeutic hypothermia before hospital admission. Infusion of ice-cold fluid after return of spontaneous circulation was found to be well tolerated and effective. This method of cooling should be considered as an important first link in the 'cold chain' of prehospital comatose cardiac arrest survivors.