Intra-arrest selective brain cooling improves success of resuscitation in a porcine model of prolonged cardiac arrest.
OBJECTIVE
We have previously demonstrated that early intra-nasal cooling improved post-resuscitation neurological outcomes. The present study utilizing a porcine model of prolonged cardiac arrest investigated the effects of intra-nasal cooling initiated at the start of cardiopulmonary resuscitation (CPR) on resuscitation success. Our hypothesis was that rapid nasal cooling initiated during "low-flow" improves return of spontaneous resuscitation (ROSC).


METHODS
In 16 domestic male pigs weighing 40+/-3 kg, VF was electrically induced and untreated for 15 min. Animals were randomized to either head cooling or control. CPR was initiated and continued for 5 min before defibrillation was attempted. Coincident with starting CPR, the hypothermic group was cooled with a RhinoChill device which produces evaporative cooling in the nasal cavity of pigs. No cooling was administrated to control animals. If ROSC was not achieved after defibrillation, CPR was resumed for 1 min prior to the next defibrillation attempt until either successful resuscitation or for a total of 15 min.


RESULTS
Seven of eight animals in the hypothermic group (87.5%) and two of eight animals in control group (25%) (p=0.04) were successfully resuscitated. At ROSC, brain temperature was increased from baseline by 0.3 degrees C in the control group, and decreased by 0.1 degrees C in the hypothermic animals. Pulmonary artery temperature was above baseline in both groups.


CONCLUSIONS
Intra-nasal cooling initiated at the start of CPR significantly improves the success of resuscitation in a porcine model of prolonged cardiac arrest. This may have occurred by preventing brain hyperthermia.
Wang
Hao
H
Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA.
Barbut
Denise
D
Tsai
Min-Shan
MS
Sun
Shijie
S
Weil
Max Harry
MH
Tang
Wanchun
W
D000281:Administration, Intranasal; D000818:Animals; D001831:Body Temperature; D001921:Brain / Q000503:physiopathology*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003080:Cold Temperature; D004195:Disease Models, Animal; D004554:Electric Countershock; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D011651:Pulmonary Artery / Q000503:physiopathology; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications