Safety and feasibility of nasopharyngeal evaporative cooling in the emergency department setting in survivors of cardiac arrest

• Published in: Resuscitation 2010-08, Vol.81 (8), p.943-949
• Main Authors: Busch, H.-J, Eichwede, F, Födisch, M, Taccone, F.S, Wöbker, G, Schwab, T, Hopf, H.-B, Tonner, P, Hachimi-Idrissi, S, Martens, P, Fritz, H, Bode, Ch, Vincent, J.-L, Inderbitzen, B, Barbut, D, Sterz, F, Janata, A
• Format: Article
• Language: English
• Subjects: Administration, Intranasal; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Body Temperature - physiology; Cardiac arrest; Cardiopulmonary Resuscitation - methods; Cold Temperature; Cooling devices; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency Service, Hospital; Equipment Design; Feasibility Studies; Female; Follow-Up Studies; Heart Arrest - physiopathology; Heart Arrest - therapy; Humans; Hypothermia; Hypothermia, Induced - instrumentation; Intensive care medicine; Male; Medical sciences; Middle Aged; Nasopharynx; Prospective Studies; Treatment Outcome
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2010.04.027

Abstract Aim Mild therapeutic hypothermia improves survival and neurologic recovery in primary comatose survivors of cardiac arrest. Cooling effectivity, safety and feasibility of nasopharyngeal cooling with the RhinoChill device (BeneChill Inc., San Diego, USA) were determined for induction of therapeutic hypothermia. Methods Eleven emergency departments and intensive care units participated in this multi-centre, single-arm descriptive study. Eighty-four patients after successful resuscitation from cardiac arrest were cooled with nasopharyngeal delivery of an evaporative coolant for 1 h. Subsequently, temperature was controlled with systemic cooling at 33 °C. Cooling rates, adverse events and neurologic outcome at hospital discharge using cerebral performance categories (CPC; CPC 1 = normal to CPC 5 = dead) were documented. Temperatures are presented as median and the range from the first to the third quartile. Results Nasopharyngeal cooling for 1 h reduced tympanic temperature by median 2.3 (1.6; 3.0) °C, core temperature by 1.1 (0.7; 1.5) °C. Nasal discoloration occurred during the procedure in 10 (12%) patients, resolved in 9, and was persistent in 1 (1%). Epistaxis was observed in 2 (2%) patients. Periorbital gas emphysema occurred in 1 (1%) patient and resolved spontaneously. Thirty-four of 84 patients (40%) patients survived, 26/34 with favorable neurological outcome (CPC of 1–2) at discharge. Conclusions Nasopharyngeal evaporative cooling used for 1 h in primary cardiac arrest survivors is feasible and safe at flow rates of 40–50 L/min in a hospital setting.