title: Early targeted brain COOLing in the cardiac CATHeterisation laboratory following cardiac arrest (COOLCATH).
abstract: BACKGROUND
  Trials demonstrate significant clinical benefit in patients receiving therapeutic hypothermia (TH) after cardiac arrest. However, incidence of mortality and morbidity remains high in this patient group. Rapid targeted brain hypothermia induction, together with prompt correction of the underlying cause may improve outcomes in these patients. This study investigates the efficacy of Rhinochill, an intranasal cooling device over Blanketrol, a surface cooling device in inducing TH in cardiac arrest patients within the cardiac catheter laboratory.
  
  
  METHODS
  70 patients were randomized to TH induction with either Rhinochill or Blanketrol. Primary outcome measures were time to reach tympanic ≤34 °C from randomisation as a surrogate for brain temperature and oesophageal ≤34 °C from randomisation as a measurement of core body temperature. Secondary outcomes included first hour temperature drop, length of stay in intensive care unit, hospital stay, neurological recovery and all-cause mortality at hospital discharge.
  
  
  RESULTS
  There was no difference in time to reach ≤34 °C between Rhinochill and Blanketrol (Tympanic ≤34 °C, 75 vs. 107 mins; p=0.101; Oesophageal ≤34 °C, 85 vs. 115 mins; p=0.151). Tympanic temperature dropped significantly with Rhinochill in the first hour (1.75 vs. 0.94 °C; p<0.001). No difference was detected in any other secondary outcome measures. Catheter laboratory-based TH induction resulted in a survival to hospital discharge of 67.1%.
  
  
  CONCLUSIONS
  In this study, Rhinochill was not found to be more efficient than Blanketrol for TH induction, although there was a non-significant trend in favour of Rhinochill that potentially warrants further investigation with a larger trial.
authors.affiliation: Post Graduate Medical Institute (PMI), Anglia Ruskin University, Chelmsford, UK; The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Shahed
authors.initials: S
authors.lastname: Islam
authors.affiliation: Post Graduate Medical Institute (PMI), Anglia Ruskin University, Chelmsford, UK.
authors.forename: James
authors.initials: J
authors.lastname: Hampton-Till
authors.affiliation: Post Graduate Medical Institute (PMI), Anglia Ruskin University, Chelmsford, UK; The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Noel
authors.initials: N
authors.lastname: Watson
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Nilanka N
authors.initials: NN
authors.lastname: Mannakkara
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hamarneh
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Teresa
authors.initials: T
authors.lastname: Webber
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Magee
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Abbey
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Rohan
authors.initials: R
authors.lastname: Jagathesan
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Alamgir
authors.initials: A
authors.lastname: Kabir
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sayer
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Robinson
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Gerald
authors.initials: G
authors.lastname: Clesham
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Reto
authors.initials: R
authors.lastname: Gamma
authors.affiliation: The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK.
authors.forename: Kare
authors.initials: K
authors.lastname: Tang
authors.affiliation: Post Graduate Medical Institute (PMI), Anglia Ruskin University, Chelmsford, UK; The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK. Electronic address: John.Davies@btuh.nhs.uk.
authors.forename: John R
authors.initials: JR
authors.lastname: Davies
authors.affiliation: Post Graduate Medical Institute (PMI), Anglia Ruskin University, Chelmsford, UK; The Essex Cardiothoracic Centre (CTC), Basildon, Essex, SS16 5NL, UK. Electronic address: thomas.keeble@btuh.nhs.uk.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Keeble
mesh_terms: D001921:Brain; D006328:Cardiac Catheterization; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors
keywords: Cardiac arrest; Cardiac catheter laboratory; Intranasal cooling; Targeted brain cooling; Therapeutic hypothermia