Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness).
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.
Castrén
Maaret
M
Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
Nordberg
Per
P
Svensson
Leif
L
Taccone
Fabio
F
Vincent
Jean-Louise
JL
Desruelles
Didier
D
Eichwede
Frank
F
Mols
Pierre
P
Schwab
Tilmann
T
Vergnion
Michel
M
Storm
Christian
C
Pesenti
Antonio
A
Pachl
Jan
J
Guérisse
Fabien
F
Elste
Thomas
T
Roessler
Markus
M
Fritz
Harald
H
Durnez
Pieterjan
P
Busch
Hans-Jörg
HJ
Inderbitzen
Becky
B
Barbut
Denise
D
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