Feasibility of intra-arrest hypothermia induction: A novel nasopharyngeal approach achieves preferential brain cooling.
OBJECTIVE
In patients with cardiopulmonary arrest, brain cooling may improve neurological outcome, especially if applied prior to or during early reperfusion. Thus it is important to develop feasible cooling methods for pre-hospital use. This study examines cerebral and compartmental thermokinetic properties of nasopharyngeal cooling during various blood flow states.


METHODS
Ten swine (40+/-4kg) were anesthetized, intubated and monitored. Temperature was determined in the frontal lobe of the brain, in the aorta, and in the rectum. After the preparatory phase the cooling device (RhinoChill system), which produces evaporative cooling in the nasopharyngeal area, was activated for 60min. The thermokinetic response was evaluated during stable anaesthesia (NF, n=3); during untreated cardiopulmonary arrest (ZF, n=3); during CPR (LF, n=4).


RESULTS
Effective brain cooling was achieved in all groups with a median cerebral temperature decrease of -4.7 degrees C for NF, -4.3 degrees C for ZF and -3.4 degrees C for LF after 60min. The initial brain cooling rate however was fastest in NF, followed by LF, and was slowest in ZF; the median brain temperature decrease from baseline after 15min of cooling was -2.48 degrees C for NF, -0.12 degrees C for ZF, and -0.93 degrees C for LF, respectively. A median aortic temperature change of -2.76 degrees C for NF, -0.97 for LF and +1.1 degrees C for ZF after 60min indicated preferential brain cooling in all groups.


CONCLUSIONS
While nasopharyngeal cooling in swine is effective at producing preferential cerebral hypothermia in various blood flow states, initial brain cooling is most efficient with normal circulation.
Center for Resuscitation Science, Department of Emergency Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA 19146, United States. mboller@vet.upenn.edu
Manuel
M
Boller
Joshua W
JW
Lampe
Joseph M
JM
Katz
Denise
D
Barbut
Lance B
LB
Becker
D000818:Animals; D001831:Body Temperature / Q000502:physiology*; D001921:Brain / Q000503:physiopathology*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003080:Cold Temperature; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D007036:Hypothermia, Induced / Q000379:methods*; D009305:Nasopharynx; D013552:Swine; D016896:Treatment Outcome