title: Ultrarapid Induction of Hypothermia Using Continuous Automated Peritoneal Lavage With Ice-Cold Fluids: Final Results of the Cooling for Cardiac Arrest or Acute ST-Elevation Myocardial Infarction Trial.
abstract: OBJECTIVE
  Hypothermia (32-34 °C) can mitigate ischemic brain injury, and some evidence suggests that it can reduce infarct size in acute myocardial infarction and acute ischemic stroke. For some indications, speed of cooling may be crucial in determining efficacy. We performed a multicenter prospective intervention study to test an ultrarapid cooling technology, the Velomedix Automated Peritoneal Lavage System using ice-cold fluids continuously circulating through the peritoneal cavity to rapidly induce and maintain hypothermia in comatose patients after cardiac arrest and a small number of awake patients with acute myocardial infarction.
  
  
  METHODS
  Multicenter prospective intervention study.
  
  
  METHODS
  Intensive care- and coronary care units of multiple tertiary referral centers.
  
  
  RESULTS
  Access to the peritoneal cavity was gained using a modified blunt dilating instrument, followed by catheter placement. Patients were cooled to a temperature of 32.5 °C, maintained for 24 hours (cardiac arrest) or 3 hours (acute myocardial infarction) followed by controlled rewarming. Forty-nine patients were enrolled, and 46 patients completed treatment. One placement was unsuccessful (abdominal wall not breached), two patients were ultimately not cooled, and only safety data are reported. Average catheter insertion time was 2.3 minutes. Mean time to temperature less than 33 °C was 10.4 minutes (average cooling rate, 14 °C/hr). Median infarct size in patients who had coronary interventions was 16% of LV. No cases of stent thrombosis occurred. Survival in cardiac arrest patients with initial rhythm of ventricular tachycardia/ventricular fibrillation was 56%, of whom 82 had a complete neurologic recovery. This compares favorably to outcomes from previous studies.
  
  
  CONCLUSIONS
  Automated peritoneal lavage system is a safe and ultrarapid method to induce and maintain hypothermia, which appears feasible in cardiac arrest patients and awake patients with acute myocardial infarction. The shivering response appeared to be delayed and much reduced with this technology, diminishing metabolic disorders associated with cooling and minimizing sedation requirement. Our data suggest that ultrarapid cooling could prevent subtle neurologic damage compared with slower cooling. This will need to be confirmed in direct comparative studies.
authors.affiliation: 1Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. 2Center for Intensive Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia. 3Department of Critical Care Medicine, VU University Medical Center, Amsterdam, The Netherlands. 4Department of Critical Care Medicine, Medisch Spectrum Twente, Enschede, The Netherlands. 5Velomedix, Menlo Park, CA. 6Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden. 7Department of Emergency Medicine, Universitätsklinik für Notfallmedizin, Vienna, Austria.
authors.forename: Kees H
authors.initials: KH
authors.lastname: Polderman
authors.forename: Marko
authors.initials: M
authors.lastname: Noc
authors.forename: Albertus
authors.initials: A
authors.lastname: Beishuizen
authors.forename: Hagen
authors.initials: H
authors.lastname: Biermann
authors.forename: Armand R J
authors.initials: AR
authors.lastname: Girbes
authors.forename: Griffeth W
authors.initials: GW
authors.lastname: Tully
authors.forename: Daniel
authors.initials: D
authors.lastname: Seidman
authors.forename: Per Arne
authors.initials: PA
authors.lastname: Albertsson
authors.forename: Michael
authors.initials: M
authors.lastname: Holmberg
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.forename: Michael
authors.initials: M
authors.lastname: Holzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003080:Cold Temperature; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007053:Ice; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D010533:Peritoneal Lavage / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D007053:Ice