title: A comparison of intravascular and surface cooling techniques in comatose cardiac arrest survivors.
abstract: OBJECTIVE
  Mild therapeutic hypothermia after out-of-hospital cardiac arrest is usually achieved either by surface cooling or by core cooling via the patient's bloodstream. We compared modern core (Coolgard) and surface (Arctic Sun) cooling devices with a zero hypothesis of equal cooling, complications, and neurologic outcomes.
  
  
  METHODS
  Single-center observational study.
  
  
  METHODS
  University hospital medical and cardiac intensive care units.
  
  
  METHODS
  One hundred sixty-seven consecutive patients comatose after out-of-hospital cardiac arrest of all causes treated with mild therapeutic hypothermia in a 5-yr period.
  
  
  METHODS
  Nonrandomized allocation to core or surface cooling depending on availability and physician preference.
  
  
  RESULTS
  All out-of-hospital cardiac arrest patients' records were reviewed for relevant data regarding medical history, cardiac arrest event, prehospital care, in-hospital treatment, and complications. Survivor neurologic function was reassessed at follow-up after 6 to 12 months. Baseline patient and arrest episode characteristics were similar in the treatment groups. There was no significant difference in survival with good neurologic function, either to hospital discharge (surface, 34/90, 38%; core, 34/75, 45%; p=.345) or at follow-up (surface, 34/88, 39%; core, 34/75, 45%; p=.387). Time from cardiac arrest to achieving mild therapeutic hypothermia was equal with both devices (surface, 273 min, interquartile range 158-330; core, 270 min, interquartile range 190-360; p=.479). There were significantly more episodes of sustained hyperglycemia among the surface-cooled patients (surface, 64/92, 70%; core, 36/75, 48%; p=.005) and significantly more hypomagnesaemia among core-cooled patients (surface, 16/87, 18%; core, 27/74, 37%; p=.01).
  
  
  CONCLUSIONS
  In this study, surface and core cooling of out-of-hospital cardiac arrest patients following the same established postresuscitation treatment protocol resulted in similar survival to hospital discharge and comparable neurologic function at follow-up.
authors.affiliation: Department of Anesthesiology, Institute for Experimental Medical Research, Surgical Intensive Care Unit, Oslo University Hospital, Oslo, Norway. oystein.tomte@medisin.uio.no
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Tømte
authors.forename: Tomas
authors.initials: T
authors.lastname: Drægni
authors.forename: Arild
authors.initials: A
authors.lastname: Mangschau
authors.forename: Dag
authors.initials: D
authors.lastname: Jacobsen
authors.forename: Bjorn
authors.initials: B
authors.lastname: Auestad
authors.forename: Kjetil
authors.initials: K
authors.lastname: Sunde
mesh_terms: D001831:Body Temperature; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D007036:Hypothermia, Induced / Q000379:methods; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008274:Magnesium / Q000097:blood; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000628:therapy*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D008274:Magnesium