Faculty Opinions recommendation of Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline.

Abstract

Many experts believe that the effectiveness of therapeutic hypothermia after cardiac arrest is optimized when it is initiated as soon as possible after the return of spontaneous circulation. However, this hypothesis has yet to be rigorously tested. This article demonstrates the feasibilty of using cold IV saline to initate post-cardiac arrest therapeutic hypothermia in the pre-hospital setting. The results suggest that this stategy will on average lower core body temperature approximately one degree celsius by the time of hospital arrival without causing significant detrimental side effects. This pilot study represents an important step in translating post-cardiac arrest care into the out-of-hospial setting. However, there are a number of limitations including inadequate power to detect a survival benefit or clinically relevant incidence of detrimental side effects. Also, there is lack of data on the time to onset and rate of cooling, and inconsistent continuation of therapeutic hypothermia after hospital arrival.