title: Efficiency and safety of a noninvasive therapeutic hypothermia protocol in cardiac arrest.
abstract: OBJECTIVE
  Therapeutic hypothermia (TH) is part of the treatment strategy for comatose survivors of cardiac arrest (CA). The aim of our study was to evaluate the efficiency and the safety of a noninvasive and affordable cooling procedure applied to all types of CA in an ICU.
  
  
  METHODS
  This was a retrospective, observational, monocenter study.
  
  
  METHODS
  In all patients remaining unconscious after CA, irrespective of their initial cardiac rhythm, TH was induced with a rapid intravenous infusion of 30 ml/kg ice-cold (4°C) saline fluid associated with external surface cooling involving ice packs and wet sheets. The body temperature was maintained between 32 and 34°C during 24 h using external surface cooling only. The patients were then passively rewarmed.
  
  
  RESULTS
  Of 200 eligible patients, 145 were treated by TH; 104 patients completed the 24-h TH treatment. The primary cause of noninclusion or secondary exclusion was severe hemodynamic impairment. From induction, the median time to reach the target temperature was 167 min (47-300 min). During the protocol, 24 patients did not remain within the targeted temperature range. Adverse events included hypokalemia (44%), severe arrhythmia (13.8%), bleeding (4.8%), and seizure (1.4%). All patients presented hyperglycemia. The oxygen partial pressure to oxygen fractional concentration (PaO2/FiO2) ratio remained constant after initiation and throughout the procedure, even in patients with poor systolic function.
  
  
  CONCLUSIONS
  This noninvasive TH procedure seems efficient and safe in all patients remaining comatose after CA. Thanks to its simplicity, it could allow prehospital cooling to reach the target temperature more rapidly.
authors.affiliation: aIntensive Care Unit, Timone University Hospital, Aix-Marseille University, Marseille bIntensive Care Unit, Sainte Musse Hospital, Toulon, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: de Bourmont
authors.forename: Didier
authors.initials: D
authors.lastname: Demory
authors.forename: Jacques
authors.initials: J
authors.lastname: Durand-Gasselin
authors.forename: Stéphane Y
authors.initials: SY
authors.lastname: Donati
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Arnal
authors.forename: Gaelle
authors.initials: G
authors.lastname: Corno
authors.forename: Pierre
authors.initials: P
authors.lastname: Michelet
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome