title: Cold infusions alone are effective for induction of therapeutic hypothermia but do not keep patients cool after cardiac arrest.
abstract: OBJECTIVE
  Cold infusions have proved to be effective for induction of therapeutic hypothermia after cardiac arrest but so far have not been used for hypothermia maintenance. This study investigates if hypothermia can be induced and maintained by repetitive infusions of cold fluids and muscle relaxants.
  
  
  METHODS
  Patients were eligible, if they had a cardiac arrest of presumed cardiac origin and no clinical signs of pulmonary oedema or severely reduced left ventricular function. Rocuronium (0.5 mg/kg bolus, 0.5 mg/kg/h for maintenance) and crystalloids (30 ml/kg/30 min for induction, 10 ml/kg every 6h for 24h maintenance) were administered via large bore peripheral venous cannulae. If patients failed to reach 33+/-1 degrees C bladder temperature within 60 min, endovascular cooling was applied.
  
  
  RESULTS
  Twenty patients with a mean age of 57 (+/-15) years and mean body mass index of 27 (+/-4)kg/m(2) were included (14 males). Mean temperature at initiation of cooling (median 27 (IQR 16; 87)min after admission) was 35.4 (+/-0.9) degrees C. In 13 patients (65%) the target temperature was reached within 60 min, 7 patients (35%) failed to reach the target temperature. Maintaining the target temperature was possible in three (15%) patients and no adverse events were observed.
  
  
  CONCLUSIONS
  Cold infusions are effective for induction of hypothermia after cardiac arrest, but for maintenance additional cooling techniques are necessary in most cases.
authors.affiliation: Department of Emergency Medicine, Medical University Vienna, Währinger Gürtel 18-20/6D, 1090 Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kliegel
authors.forename: Andreas
authors.initials: A
authors.lastname: Janata
authors.forename: Cosima
authors.initials: C
authors.lastname: Wandaller
authors.forename: Thomas
authors.initials: T
authors.lastname: Uray
authors.forename: Alexander
authors.initials: A
authors.lastname: Spiel
authors.forename: Heidrun
authors.initials: H
authors.lastname: Losert
authors.forename: Matthias
authors.initials: M
authors.lastname: Kliegel
authors.forename: Michael
authors.initials: M
authors.lastname: Holzer
authors.forename: Moritz
authors.initials: M
authors.lastname: Haugk
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.forename: Anton N
authors.initials: AN
authors.lastname: Laggner
mesh_terms: D000367:Age Factors; D000465:Algorithms; D000732:Androstanols / Q000627:therapeutic use; D015992:Body Mass Index; D002406:Catheterization, Peripheral; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007262:Infusions, Intravenous; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use; D011446:Prospective Studies; D015532:Rehydration Solutions; D000077331:Ringer's Solution; D000077123:Rocuronium; D012462:Saline Solution, Hypertonic; D012494:Sampling Studies
chemical_list: D000732:Androstanols; D007552:Isotonic Solutions; D009125:Muscle Relaxants, Central; D003473:Neuromuscular Nondepolarizing Agents; D015532:Rehydration Solutions; D012462:Saline Solution, Hypertonic; D000077331:Ringer's Solution; D000077123:Rocuronium