title: Cold simple intravenous infusions preceding special endovascular cooling for faster induction of mild hypothermia after cardiac arrest--a feasibility study.
abstract: OBJECTIVE
  Mild therapeutic hypothermia has shown to improve neurological outcome after cardiac arrest. Our study investigated the efficacy and safety of cold simple intravenous infusions for induction of hypothermia after cardiac arrest preceding further cooling and maintenance of hypothermia by specialised endovascular cooling.
  
  
  METHODS
  All patients admitted after cardiac arrest of presumed cardiac aetiology were screened. Patients enrolled received 2000 ml of ice-cold (4 degrees C) fluids via peripheral venous catheters. As soon as possible endovascular cooling was applied even if the cold infusions were not completed. The target temperature was defined as 33 +/- 1 degrees C. All temperatures recorded were measured via bladder-temperature probes. The primary endpoint was the time from return of spontaneous circulation to reaching the target temperature. Secondary endpoints were changes in haemodynamic variables, oxygenation, haemoglobin, clotting variables and neurological outcome.
  
  
  RESULTS
  Out of 167 screened patients 26 (15%) were included. With a total amount of 24 +/- 7 ml/kg cold fluid at 4 degrees C the temperature could be lowered from 35.6 +/- 1.3 degrees C on admission to 33.8 +/- 1.1 degrees C. The target temperature was reached 185 +/- 119 min after return of spontaneous circulation, 135 +/- 112 min after start of infusion, and 83 +/- 85 min after start of endovascular cooling. Except for two patients showing radiographic signs of mild pulmonary edema no complications attributable to the infusions could be observed. Thirteen patients (50%) survived with favourable neurological outcome.
  
  
  CONCLUSIONS
  Our results indicate that induction of mild hypothermia with infusion of cold fluids preceding endovascular cooling is safe and effective.
authors.affiliation: Department of Emergency Medicine, Medical University Vienna, 1090 Wien, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kliegel
authors.forename: Heidrun
authors.initials: H
authors.lastname: Losert
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.forename: Matthias
authors.initials: M
authors.lastname: Kliegel
authors.forename: Michael
authors.initials: M
authors.lastname: Holzer
authors.forename: Thomas
authors.initials: T
authors.lastname: Uray
authors.forename: Hans
authors.initials: H
authors.lastname: Domanovits
mesh_terms: D022561:Advanced Cardiac Life Support; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012449:Safety; D013997:Time Factors