title: Intravascular versus surface cooling speed and stability after cardiopulmonary resuscitation.
abstract: OBJECTIVE
  Mild therapeutic hypothermia (MTH) is used to limit neurological injury and improve survival after cardiac arrest (CA) and cardiopulmonary resuscitation, but the optimal mode of cooling is controversial. We therefore compared the effectiveness of MTH using invasive intravascular or non-invasive surface cooling with temperature feedback control.
  
  
  METHODS
  This retrospective study in post-CA patients studied the effects of intravascular cooling (CoolGard, Zoll, n=97), applied on the intensive care unit (ICU) in one university hospital compared with those of surface cooling (Medi-Therm, Gaymar, n=76) applied in another university hospital.
  
  
  RESULTS
  Time to reach target temperature and cooling speeds did not differ between groups. During the maintenance phase, mean core temperature was 33.1°C (range 32.7-33.7°C) versus 32.5°C (range 31.7-33.4°C) at targets of 33.0 and 32.5°C in intravascularly versus surface cooled patients, respectively. The variation coefficient for temperature during maintenance was higher in the surface than the intravascular cooling group (mean 0.85% vs 0.35%, p<0.0001). ICU survival was 60% and 50% in the intravascularly and surface cooled groups, respectively (NS). Lower age (OR 0.95; 95% CI 0.93 to 0.98; p<0.0001), ventricular fibrillation/ventricular tachycardia as presenting rhythm (OR 7.6; 95% CI 1.8 to 8.9; p<0.0001) and lower mean temperature during the maintenance phase (OR 0.52; 95% CI 0.25 to 1.08; p=0.081) might be independent determinants of ICU survival, while cooling technique and temperature variability did not contribute.
  
  
  CONCLUSIONS
  In post-CA patients, intravascular cooling systems result in equal cooling speed, but less variation in temperature during the maintenance phase, as surface cooling. This may not affect the outcome.
authors.affiliation: Department of Intensive Care, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: de Waard
authors.affiliation: Department of Intensive Care, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: R P
authors.initials: RP
authors.lastname: Banwarie
authors.affiliation: Department of Intensive Care, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: L S D
authors.initials: LS
authors.lastname: Jewbali
authors.affiliation: Department of Intensive Care, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Struijs
authors.affiliation: Department of Intensive Care, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: A R J
authors.initials: AR
authors.lastname: Girbes
authors.affiliation: Department of Intensive Care, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: A B J
authors.initials: AB
authors.lastname: Groeneveld
mesh_terms: D000368:Aged; D001831:Body Temperature / Q000502:physiology; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003080:Cold Temperature; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: resuscitation, effectiveness; resuscitation, research