title: Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room.
abstract: OBJECTIVE
  Cooling the pharynx and upper oesophagus would be more advantageous for rapid induction of therapeutic hypothermia since the carotid arteries run in their vicinity. The aim of this study was to determine the effects of pharyngeal cooling on brain temperature and the safety and feasibility for patients under resuscitation.
  
  
  METHODS
  Witnessed non-traumatic cardiac arrest patients (n=108) were randomized to receive standard care with (n=53) or without pharyngeal cooling (n=55). In the emergency room, pharyngeal cooling was initiated before or shortly after return of spontaneous circulation by perfusing physiological saline (5 °C) into a pharyngeal cuff for 120 min.
  
  
  RESULTS
  There was a significant decrease in tympanic temperature at 40 min after arrival (P=0.02) with a maximum difference between the groups at 120 min (32.9 ± 1.2°C, pharyngeal cooling group vs. 34.1 ± 1.3°C, control group; P<0.001). The return of spontaneous circulation (70% vs. 65%, P=0.63) and rearrest (38% vs. 47%, P=0.45) rates were not significantly different based on the initiation of pharyngeal cooling. No post-treatment mechanical or cold-related injury was observed on the pharyngeal epithelium by macroscopic observation. The thrombocytopaenia incidence was lower in the pharyngeal cooling group (P=0.001) during the 3-day period after arrival. The cumulative survival rate at 1 month was not significantly different between the two groups.
  
  
  CONCLUSIONS
  Initiation of pharyngeal cooling before or immediately after the return of spontaneous circulation is safe and feasible. Pharyngeal cooling can rapidly decrease tympanic temperature without adverse effects on circulation or the pharyngeal epithelium.
authors.affiliation: Department of Anesthesiology, Okayama University Medical School, 2-5-1 Shikata-cho Kita-ku, Okayama 700-8558, Japan. Electronic address: yoshit@cc.okayama-u.ac.jp.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Takeda
authors.affiliation: Department of Emergency and Critical Care Medicine, Iseikai Hospital, 6-2-25 Sugahara Higashiyodogawa-ku, Osaka 533-0022, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kawashima
authors.affiliation: Tertiary Emergency Medical Center, Saitama Red-Cross Hospital, 8-3-33 Kamiochiai Chuo-ku, Saitama 338-0001, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kiyota
authors.affiliation: Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba 260-0856, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Oda
authors.affiliation: Emergency and Critical Care Center, Tsuyama Central Hospital, 1756 Kawasaki Tsuyama, Okayama 708-0841, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Morimoto
authors.affiliation: Osaka Mishima Emergency Critical Care Center, 11-1 Minamiakutagawacho Takatsuki, Osaka 569-1124, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kobata
authors.affiliation: Department of Emergency Diagnosis and Treatment, Himeji Medical Center, 68 Honmachi Himeji, Hyogo 670-0012, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Isobe
authors.affiliation: Emergency and Critical Care Center, Toho University Faculty of Medicine, 5-21-16 Omorinishi Ota-ku, Tokyo 143-0015, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Honda
authors.affiliation: Critical Care and Trauma Center, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-ku, Osaka 558-0056, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fujimi
authors.affiliation: Department of Neurosurgery, Kitakyushu Yugawa Hospital, 2-1-10 Kuzuhara Kitakyushu Kokuraminami-ku, Fukuoka 800-0251, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Onda
authors.affiliation: Department of Emergency Medicine, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamineminami Higashi-ku, Kumamoto 861-8039, Japan.
authors.forename: Seishi
authors.initials: S
authors.lastname: I
authors.affiliation: Trauma and Resuscitation Center, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo 173-0003, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Emergency Department, Kure Kyosai Hospital, 2-3-28 Nishichuo Kure, Hiroshima 737-0811, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Ishikawa
authors.affiliation: Emergency Department, Okazaki City Hospital, 3-1 Goshoai Koryujicho, Okazaki, Aichi 444-0002, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakano
authors.affiliation: Emergency and Critical Care Center, Osaka Medical Center, 2-1-14 Hoenzaka Chuo-ku, Osaka 540-0006, Japan.
authors.forename: Daikai
authors.initials: D
authors.lastname: Sadamitsu
authors.affiliation: Emergency and Critical Care Center, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin Chuo-ku, Fukuoka 810-0001, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Kishikawa
authors.affiliation: Emergency and Critical Care Center, Nihon University Itabashi Hospital, 30 Oyaguchikamicho Itabashi-ku, Tokyo 173-0032, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Kinoshita
authors.affiliation: Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo 193-0944, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yokoyama
authors.affiliation: Emergency and Critical Care Center, Kumamoto Medical Center, 1-5 Ninomaru Chuo-ku, Kumamoto 860-0008, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Harada
authors.affiliation: Department of Emergency and Critical Care Medicine, Kagawa Rosai Hospital, 3-3-1 Jotocho Marugame, Kagawa 763-0013, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Kitaura
authors.affiliation: Department of Clinical Laboratory Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi Ube, Yamaguchi 755-0046, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ichihara
authors.affiliation: Daiken Medical Co., 3-6-1 Doshomachi Chuo-ku, Osaka 541-0045, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hashimoto
authors.affiliation: Daiken Medical Co., 3-6-1 Doshomachi Chuo-ku, Osaka 541-0045, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tsuji
authors.affiliation: Department of Human Ecology, Okayama University Graduate School of Environmental and Life Science, 2-5-1 Shikata-cho Kita-ku, Okayama 700-8558, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yorifuji
authors.affiliation: Department of Disaster and Emergency Medicine, Kochi University Medical School, Okochokohasu Nankoku, Kochi 783-8505, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Nagano
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Kawasaki Medical School, 2-1-80 Nakasange Kita-ku, Okayama 700-0821, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Katayama
authors.affiliation: Department of Emergency and Critical Care Medicine, Okayama University Medical School, 2-5-1 Shikata-cho Kita-ku, Okayama 700-8558, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Ujike
authors.affiliation: Okayama University, 1-1-1 Tsushimanaka Kita-ku, Okayama 700-0082, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Morita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature / Q000502:physiology*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004636:Emergency Service, Hospital; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010614:Pharynx; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brain ischaemia; Cardiac arrest; Intra-arrest cooling; Pharynx; Selective cooling; Therapeutic hypothermia