title: Effect of prehospital initiation of therapeutic hypothermia in adults with cardiac arrest on time-to-target temperature.
abstract: OBJECTIVE
  Despite growing adoption, the impact of prehospital initiation of therapeutic hypothermia on outcomes of cardiac arrest patients is unknown. The objective of this study was to determine if prehospital administration of cold intravenous fluids improved the time-to-target temperature.
  
  
  METHODS
  All patients enrolled in an institutional post- cardiac arrest treatment pathway were prospectively registered into a quality assurance database. Patients undergoing cooling induction on hospital arrival were compared to those receiving a new treatment protocol initiated during the study period involving prehospital cooling with 4°C (39.2°F) normal saline. The primary outcome was the time-to-target temperature. Secondary outcomes included emergency medicine system transport time metrics, mortality, and neurologic status at discharge and 1 year.
  
  
  RESULTS
  One hundred thirty-two patients were enrolled during the study period. The initial rhythm was ventricular fibrillation/tachycardia in 63% and asystole/pulseless electrical activity in 36%. Eighty patients received prehospital cooling and 52 patients did not and comprised the historical control group. Time-to-target temperatures were not significantly different between prehospital and hospital cooled groups (256 v. 271 minutes, respectively, p=0.64), nor was there any improvement in hospital survival (54% v. 50%, p=0.67), good neurologic outcome (49% v. 44%, p=0.61), or 1- year survival (49% v. 42%, p=0.46) between the two groups. Transport times were longer in the prehospital cooled group.
  
  
  CONCLUSIONS
  Out-of-hospital cardiac arrest patients treated with prehospital cooling before arrival at our urban hospital did not have faster time-to-target temperature or improvement in outcomes compared to patients cooled immediately on emergency department arrival. Further research is needed to determine if any benefits exist from prehospital cooling prior to its widespread adoption.
authors.affiliation: *Utah Emergency Physicians,Department of Emergency Medicine,Intermountain Medical Center,Intermountain Healthcare,Salt Lake City,UT.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Schenfeld
authors.affiliation: †Mecklenburg EMS Agency,Charlotte,NC.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Studnek
authors.affiliation: ‡Division of Critical Care Medicine,Department of Internal Medicine,Carolinas Medical Center,Charlotte,NC.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Heffner
authors.affiliation: ∥Carolinas Health Care System,Dickson Advanced Analytics Group,Charlotte,NC.
authors.forename: Marcy
authors.initials: M
authors.lastname: Nussbaum
authors.affiliation: ∥Carolinas Health Care System,Dickson Advanced Analytics Group,Charlotte,NC.
authors.forename: Kathi
authors.initials: K
authors.lastname: Kraft
authors.affiliation: §Department of Emergency Medicine,Carolinas Medical Center,Charlotte,NC.
authors.forename: David A
authors.initials: DA
authors.lastname: Pearson
mesh_terms: D000328:Adult; D001831:Body Temperature; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000503:physiopathology / Q000628:therapy*
keywords: cardiac arrest; prehospital medicine; therapeutic hypothermia