Elsevier

Resuscitation

Volume 62, Issue 3, September 2004, Pages 299-302
Resuscitation

Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer’s solution: a pilot study

https://doi.org/10.1016/j.resuscitation.2004.04.003Get rights and content

Abstract

The cooling and haemodynamic effects of prehospital infusion of ice-cold Ringer’s solution were studied in 13 adult patients after successful resuscitation from non-traumatic cardiac arrest. After haemodynamics stabilisation, 30 ml/kg of Ringer’s solution was infused at a rate of 100 ml/min into the antecubital vein. Arterial blood pressure and blood gases, pulse rate, end-tidal CO2 and oesophageal temperature were monitored closely. The mean core temperature decreased from 35.8 ± 0.9 °C at the start of infusion to 34.0 ± 1.2 °C on arrival at hospital (P < 0.0001). No serious adverse haemodynamic effects occurred. It is concluded that the induction of therapeutic hypothermia using this technique in the prehospital setting is feasible.

Sumàrio

Foram estudados os efeitos hemodinâmicos e o arrefecimento induzidos pela perfusão pré hospitalar de uma solução de Ringer gelada perfundida a 100 ml/min na veia antecubital. Monitorizaram-se apertadamente a pressão arterial e os gases sangue, a frequência de pulso, o CO2 no final da expiração e a temperatura esofágica. A temperatura média central diminuiu de 35.8 ± 0.9 °C no inı́cio da perfusão para 34.0 ± 1.2 °C na chegada ao hospital (P < 0.0001). Não ocorreram efeitos hemodinâmicos adversos severos. Concluı́mos que é exequı́vel a indução de terapêutica hipotérmica com esta técnica no ambiente pré-hospitalar.

Resumen

Se estudiaron los efectos hemodinámicos y el enfriamiento producidos por la infusión prehospitalaria de solución muy frı́a de Ringer, en 13 pacientes adultos después de la resucitación exitosa de paro cardı́aco no traumático. Después de estabilizar la hemodinamia, se infundieron 30 ml/kg de solución de Ringer a una velocidad de 100 ml/min en la vena antecubital. Se monitorearon estrechamente presión arterial y gases en sangre, frecuencia de pulso, CO2 espiratorio y temperatura esofágica. La temperatura central promedio bajo de 35.8 ± 0.9 °C al inicio de la infusión a 34.0 ± 1.2 °C a la llegada al hospital (P < 0.0001). No ocurrieron efectos hemodinámicas adversos severos. Se concluye que es factible la inducción de hipotermia terapéutica en el ambiente prehospitalario usando esta técnica.

Introduction

Mild therapeutic hypothermia improves neurological outcome after cardiac arrest [1], [2]. It has been suggested that hypothermia should be induced as soon as possible after return of spontaneous circulation (ROSC) [3]. The earliest possible induction of hypothermia implies that the technique should be available in the prehospital setting and that it should be capable of being undertaken easily by non-physician prehospital care providers. The purpose of this study was to investigate the haemodynamic and cooling effects of infusing ice-cold Ringer’s solution immediately after ROSC in closely monitored prehospital patients using a technique described recently [4], but which has not been used in the prehospital setting before.

Section snippets

Material and methods

We enrolled 13 prehospital cardiac arrest patients treated by the physician staffed Helsinki Area Helicopter Emergency Medical Air Service (Helsinki Area, HEMS). The study protocol was approved by the institutional review board of Helsinki University Hospital, Finland. Written informed consent was obtained from relatives of the patients before induction of hypothermia. Inclusion criteria were age more than 18 years, cardiac arrest not due to trauma or drug overdose, ROSC later than 10 min from

Results

Research data and demographics are shown in Table 1. The mean age of eight male and five female patients was 60.8 ± 12.5 years. ROSC was achieved at 26 ± 10 min. Initial cardiac rhythm was ventricular fibrillation (53.8%), asystole (30.8%) or pulseless electrical activity (15.4%). The oesophageal temperature decreased significantly during treatment (Fig. 1). The mean infused volume was 2188 ± 754 ml. Infusion started at 27 ± 12 min after ROSC and mean duration of infusion was 25 ± 11 min. One

Discussion

The results of this pilot study suggest that induction of therapeutic hypothermia with rapid infusion of ice-cold Ringer’s solution soon after ROSC is well tolerated and feasible in the prehospital setting. This treatment has been documented in hospitalised patients starting, on average, 73 min after ROSC [4]. However, the cardiovascular situation might be different immediately after ROSC, and the haemodynamic effects of induction of cooling by infusion at this stage have not been reported,

Conclusion

We conclude that induction of therapeutic hypothermia with peripheral infusion of ice-cold Ringer’s solution seems feasible soon after ROSC in the prehospital setting. Because this technique is also readily available to non-physician care providers, the induction of therapeutic hypothermia can be started earlier if found safe and well tolerated in larger trials.

Acknowledgements

We would like to thank the crew of the Helsinki Area HEMS for the valuable help in enrolling the study patients. This study was supported by institutional EVO grant #9B102 from Special State Allocation via Tampere University Hospital.

References (7)

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