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Resuscitation. 2010 May;81(5):617-21. doi: 10.1016/j.resuscitation.2010.01.027. Epub 2010 Mar 6.

Intra-arrest selective brain cooling improves success of resuscitation in a porcine model of prolonged cardiac arrest.

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1
Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA.

Abstract

AIMS OF STUDY:

We have previously demonstrated that early intra-nasal cooling improved post-resuscitation neurological outcomes. The present study utilizing a porcine model of prolonged cardiac arrest investigated the effects of intra-nasal cooling initiated at the start of cardiopulmonary resuscitation (CPR) on resuscitation success. Our hypothesis was that rapid nasal cooling initiated during "low-flow" improves return of spontaneous resuscitation (ROSC).

METHODS:

In 16 domestic male pigs weighing 40+/-3 kg, VF was electrically induced and untreated for 15 min. Animals were randomized to either head cooling or control. CPR was initiated and continued for 5 min before defibrillation was attempted. Coincident with starting CPR, the hypothermic group was cooled with a RhinoChill device which produces evaporative cooling in the nasal cavity of pigs. No cooling was administrated to control animals. If ROSC was not achieved after defibrillation, CPR was resumed for 1 min prior to the next defibrillation attempt until either successful resuscitation or for a total of 15 min.

MAIN RESULTS:

Seven of eight animals in the hypothermic group (87.5%) and two of eight animals in control group (25%) (p=0.04) were successfully resuscitated. At ROSC, brain temperature was increased from baseline by 0.3 degrees C in the control group, and decreased by 0.1 degrees C in the hypothermic animals. Pulmonary artery temperature was above baseline in both groups.

CONCLUSION:

Intra-nasal cooling initiated at the start of CPR significantly improves the success of resuscitation in a porcine model of prolonged cardiac arrest. This may have occurred by preventing brain hyperthermia.

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