title: Intraosseous infusion of ice cold saline is less efficacious than intravenous infusion for induction of mild therapeutic hypothermia in a swine model of cardiac arrest.
abstract: BACKGROUND
  Intravenous (IV) infusion of ice cold saline is an effective method to initiate induction of mild therapeutic hypothermia (MTH) following resuscitation from out-of-hospital cardiac arrest (OOHCA). Intraosseous (IO) infusion of cold saline may be an alternative method to induce MTH.
  
  
  OBJECTIVE
  The goal of this study was to determine if IO infusion of cold saline is a comparable alternative to IV infusion for inducing MTH in a laboratory swine model of cardiac arrest.
  
  
  METHODS
  Ten mixed breed swine were resuscitated from cardiac arrest and randomized post-resuscitation to infusion with ice cold saline using either IO (n = 5) or IV (n = 5) access. The study endpoints were either a goal esophageal temperature of 34 °C or the elapse of a 30 min time period, simulating a long prehospital transport.
  
  
  RESULTS
  Four of five pigs in the IV infusion group achieved goal temperature within 30 min compared to 0/5 in the IO infusion group (p = 0.048). The mean esophageal temperature change was significantly higher in the IV group when compared to the IO group (p < 0.001). Post-arrest hemodynamic parameters were similar between the two groups.
  
  
  CONCLUSIONS
  IV infusion of ice cold saline is an efficacious method to achieve MTH in this swine model of cardiac arrest. Furthermore, IO infusion of cold saline is not sufficient to induce MTH in the time routinely available in the prehospital setting following OOHCA.
authors.affiliation: Department of Emergency Medicine, University of Colorado Denver School of Medicine, 12401 East 17th Avenue B215, Denver, CO 80045, United States. Todd.Larabee@ucdenver.edu
authors.forename: Todd M
authors.initials: TM
authors.lastname: Larabee
authors.forename: Jenny A
authors.initials: JA
authors.lastname: Campbell
authors.forename: Fred A
authors.initials: FA
authors.lastname: Severyn
authors.forename: Charles M
authors.initials: CM
authors.lastname: Little
mesh_terms: D000818:Animals; D001831:Body Temperature / Q000502:physiology; D003080:Cold Temperature; D004195:Disease Models, Animal; D007036:Hypothermia, Induced / Q000379:methods*; D017148:Infusions, Intraosseous; D007262:Infusions, Intravenous; D058687:Out-of-Hospital Cardiac Arrest / Q000503:physiopathology / Q000628:therapy*; D012965:Sodium Chloride / Q000008:administration & dosage*; D013552:Swine; D016896:Treatment Outcome
chemical_list: D012965:Sodium Chloride