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Prehospital Cooling After Cardiac Arrest Is Not Necessary

November 20, 2013

Prehospital Cooling After Cardiac Arrest Is Not Necessary

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Patients actively cooled by paramedics had similar outcomes to patients cooled only after hospital arrival.

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Therapeutic hypothermia is guideline-recommended for comatose patients after cardiac arrest, but previous small studies of cooling prior to hospital arrival did not demonstrate benefit (NEJM JW Emerg Med Mar 9 2012, NEJM JW Emerg Med Sep 24 2010). Researchers in Washington State randomized cardiac arrest patients to standard care with or without paramedic-initiated cooling with intravenous 4°C normal saline, to determine the effect of prehospital cooling on survival and neurological status at hospital discharge.

Of 1359 patients, 583 had ventricular fibrillation and 776 did not. Mortality was similar in the prehospital-cooled and control groups; in patients with ventricular fibrillation (VF), 63% and 64% survived to discharge, while in patients without VF, 19% and 16% survived. Similarly, there was no difference in neurological outcomes; in patients with VF, 58% and 62% had full recovery or mild impairment, while in patients without VF, 14% and 13% had full recovery or mild impairment. Notably, patients whose cooling was initiated by paramedics achieved the target temperature of 34°C about 1 hour faster than those whose cooling was begun only after hospital arrival.

Comment

Consistent with the findings of earlier studies, initiating cooling before hospital arrival does not benefit patients who survive cardiac arrest. Efforts in the prehospital arena should continue to focus on rapid transport and treatment using proven interventions. Perhaps the greater question is whether cooling confers any real benefit at all, regardless of where it is initiated.

  • Disclosures for Ali S. Raja, MD, MBA, MPH, FACEP at time of publication Consultant / Advisory board Diagnotion, LLC Speaker's bureau Airway Management Education Center Grant / research support NHLBI; Brigham and Women’s Hospital Eleanor and Miles Shore Award; Harvard Medical School Milton Foundation; DHHS/CMS; NIBIB Editorial boards Western Journal of Emergency Medicine Leadership positions in professional societies Society for Academic Emergency Medicine; Brigham and Women’s Physician Organization

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