title: Therapeutic hypothermia after cardiac arrest: performance characteristics and safety of surface cooling with or without endovascular cooling.
abstract: BACKGROUND
  Various methods are available to induce and maintain therapeutic hypothermia after cardiac arrest, but little data is available comparing device-mediated cooling to simple surface methods in this setting.
  
  
  METHODS
  To assess the performance characteristics of simple surface cooling with or without an endovascular cooling catheter system, we retrospectively reviewed all cases of hypothermia for comatose survivors of cardiac arrest treated at a single academically affiliated urban hospital. Forty two comatose survivors of cardiac arrest were treated over a 3.5-year period. Hypothermia was induced and maintained by simple surface methods (ice packs, cooling blankets) with or without placement of an endovascular cooling catheter system with automated temperature feedback regulation.
  
  
  RESULTS
  Overall, the rate of active cooling was not different between patients treated with endovascular catheter-assisted hypothermia and patients treated with surface cooling alone. However, use of a larger (14 F) catheter was associated with faster cooling rates. Maintenance of goal temperature (33 degrees C) was far better controlled with the use of a cooling catheter. Use of surface cooling alone was associated with significant temperature overshoot. Patients treated with surface cooling alone spent more time bradycardic.
  
  
  CONCLUSIONS
  Use of an endovascular cooling catheter as part of a treatment protocol for hypothermia after cardiac arrest provides better control during maintenance of hypothermia, preventing temperature overshoot. Active cooling rates may be enhanced by the use of a larger cooling catheter.
authors.affiliation: Neurovascular and Neurocritical Care Service, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0114, USA. alex.flint@ucsfmedctr.org
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Flint
authors.forename: J Claude
authors.initials: JC
authors.lastname: Hemphill
authors.forename: David C
authors.initials: DC
authors.lastname: Bonovich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D002404:Catheterization; D003080:Cold Temperature; D003128:Coma / Q000628:therapy; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation* / Q000379:methods*; D002534:Hypoxia, Brain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome