A rapid, safe, and low-cost technique for the induction of mild therapeutic hypothermia in post-cardiac arrest patients.
OBJECTIVE
The benefits of inducing mild therapeutic hypothermia (MTH) in cardiac arrest patients are well established. Timing and speed of induction have been related to improved outcomes in several animal trials and one human study. We report the results of an easily implemented, rapid, safe, and low-cost protocol for the induction of MTH.


METHODS
All in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients admitted to an intensive care unit meeting inclusion criteria were cooled using a combination modality of rapid, cold saline infusion (CSI), evaporative surface cooling, and ice water gastric lavage. Cooling tasks were performed with a primary emphasis on speed. The main endpoints were the time intervals between return of spontaneous circulation (ROSC), initiation of hypothermia (IH), and achievement of target temperature (TT).


RESULTS
65 patients underwent MTH during a 3-year period. All patients reached target temperature. Median ROSC-TT was 134min. Median ROSC-IH was 68min. Median IH-TT was 60min. IH-TT cooling rate was 2.6°C/h. Complications were similar to that of other large trials. 31% of this mixed population of IHCA and OHCA patients recovered to a Pittsburgh cerebral performance score (CPC) of 1 or 2.


CONCLUSIONS
A protocol using a combination of core and surface cooling modalities was rapid, safe, and low cost in achieving MTH. The cooling rate of 2.6°C/h was superior to most published protocols. This method uses readily available equipment and reduces the need for costly commercial devices.
Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Medical Center, 7th Floor Dazian Building, New York, NY 10003, United States. pkory@chpnet.org
Pierre
P
Kory
Justin
J
Weiner
Joseph P
JP
Mathew
Mayuko
M
Fukunaga
Veronica
V
Palmero
Bimaljeet
B
Singh
Stephanie
S
Haimowitz
Elana T
ET
Clark
Alyssa
A
Fischer
Paul H
PH
Mayo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000191:economics* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome