title: Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness).
abstract: BACKGROUND
  Transnasal evaporative cooling has sufficient heat transfer capacity for effective intra-arrest cooling and improves survival in swine. The aim of this study was to determine the safety, feasibility, and cooling efficacy of prehospital transnasal cooling in humans and to explore its effects on neurologically intact survival to hospital discharge.
  
  
  RESULTS
  Witnessed cardiac arrest patients with a treatment interval <or=20 minutes were randomized to intra-arrest cooling with a RhinoChill device (treatment group, n=96) versus standard care (control group, n=104). The final analysis included 93 versus 101 patients, respectively. Both groups were cooled after hospital arrival. The patients had similar demographics, initial rhythms, rates of bystander cardiopulmonary resuscitation, and intervals to cardiopulmonary resuscitation and arrival of advanced life support personnel. Eighteen device-related adverse events (1 periorbital emphysema, 3 epistaxis, 1 perioral bleed, and 13 nasal discolorations) were reported. Time to target temperature of 34 degrees C was shorter in the treatment group for both tympanic (102 versus 282 minutes, P=0.03) and core (155 versus 284 minutes, P=0.13) temperature. There were no significant differences in rates of return of spontaneous circulation between the groups (38% in treated subjects versus 43% in control subjects, P=0.48), in overall survival of those admitted alive (44% versus 31%, respectively, P=0.26), or in neurologically intact survival to discharge (Pittsburgh cerebral performance category scale 1 to 2, 34% versus 21%, P=0.21), although the study was not adequately powered to detect changes in these outcomes.
  
  
  CONCLUSIONS
  Prehospital intra-arrest transnasal cooling is safe and feasible and is associated with a significant improvement in the time intervals required to cool patients.
authors.affiliation: Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
authors.forename: Per
authors.initials: P
authors.lastname: Nordberg
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
authors.forename: Fabio
authors.initials: F
authors.lastname: Taccone
authors.forename: Jean-Louise
authors.initials: JL
authors.lastname: Vincent
authors.forename: Didier
authors.initials: D
authors.lastname: Desruelles
authors.forename: Frank
authors.initials: F
authors.lastname: Eichwede
authors.forename: Pierre
authors.initials: P
authors.lastname: Mols
authors.forename: Tilmann
authors.initials: T
authors.lastname: Schwab
authors.forename: Michel
authors.initials: M
authors.lastname: Vergnion
authors.forename: Christian
authors.initials: C
authors.lastname: Storm
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
authors.forename: Jan
authors.initials: J
authors.lastname: Pachl
authors.forename: Fabien
authors.initials: F
authors.lastname: Guérisse
authors.forename: Thomas
authors.initials: T
authors.lastname: Elste
authors.forename: Markus
authors.initials: M
authors.lastname: Roessler
authors.forename: Harald
authors.initials: H
authors.lastname: Fritz
authors.forename: Pieterjan
authors.initials: P
authors.lastname: Durnez
authors.forename: Hans-Jörg
authors.initials: HJ
authors.lastname: Busch
authors.forename: Becky
authors.initials: B
authors.lastname: Inderbitzen
authors.forename: Denise
authors.initials: D
authors.lastname: Barbut
mesh_terms: D000281:Administration, Intranasal; D000368:Aged; D001831:Body Temperature / Q000502:physiology; D003080:Cold Temperature; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors