Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report.
OBJECTIVE
Recent studies have shown that induced hypothermia for twelve to twenty four hours improves outcome in patients who are resuscitated from out-of-hospital cardiac arrest. These studies used surface cooling, but this technique provided for relatively slow decreases in core temperature. Results from animal models suggest that further improvements in outcome may be possible if hypothermia is induced earlier after resuscitation from cardiac arrest. We hypothesized that a rapid infusion of large volume (30 ml/kg), ice-cold (4 degrees C) intravenous fluid would be a safe, rapid and inexpensive technique to induce mild hypothermia in comatose survivors of out-of-hospital cardiac arrest.


METHODS
We enrolled 22 patients who were comatose following resuscitation from out-of-hospital cardiac arrest. After initial evaluation in the Emergency Department (ED), a large volume (30 ml/kg) of ice-cold (4 degrees C) lactated Ringers solution was infused intravenously over 30 min. Data on vital signs, arterial blood gas, electrolyte and hematological was collected immediately before and after the infusion.


RESULTS
The rapid infusion of large volume, ice-cold crystalloid fluid resulted in a significant decrease in median core temperature from 35.5 to 33.8 degrees C. There were also significant improvements in mean arterial blood pressure, renal function and acid-base analysis. No patient developed pulmonary odema.


CONCLUSIONS
A rapid infusion of large volume, ice-cold crystalloid fluid is an inexpensive and effective method of inducing mild hypothermia in comatose survivors of out-of-hospital cardiac arrest, and is associated with beneficial haemodynamic, renal and acid-base effects. Further studies of this technique are warranted.
Bernard
Stephen
S
The Intensive Care Unit, Dandenong Hospital, David St, Victoria 3175, Dandenong, Australia. stephen.bernard@dhs.vic.gov.au
Buist
Michael
M
Monteiro
Orlando
O
Smith
Karen
K
D000136:Acid-Base Equilibrium / Q000502:physiology; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001831:Body Temperature; D003128:Coma / Q000628:therapy; D004632:Emergency Medical Services / Q000379:methods*; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007668:Kidney / Q000502:physiology; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods*; D016896:Treatment Outcome