A randomized controlled trial comparing the Arctic Sun to standard cooling for induction of hypothermia after cardiac arrest

Abstract

Context Hypothermia improves neurological outcome for comatose survivors of out-of-hospital cardiac arrest. Use of computer controlled high surface area devices for cooling may lead to faster cooling rates and potentially improve patient outcome. Objective To compare the effectiveness of surface cooling with the standard blankets and ice packs to the Arctic Sun, a mechanical device used for temperature management. Design, Setting, and Patients Multi-center randomized trial of hemodynamically stable comatose survivors of out-of-hospital cardiac arrest. Intervention Standard post-resuscitative care inducing hypothermia using cooling blankets and ice (n=30) or the Arctic Sun (n=34). Main Outcome Measures The primary end point was the proportion of subjects who reached a target temperature within 4 hours of beginning cooling. The secondary end points were time interval to achieve target temperature (34°) and survival to 3 months. Results The proportion of subjects cooled below the 34°C target at 4 hours was 71% for the Arctic Sun group and 50% for the standard cooling group (p=0.12). The median time to target was 54 minutes faster for cooled patients in the Arctic Sun group than the standard cooling group (p<0.01). Survival rates with good neurological outcome were similar; 46% of Arctic Sun patients and 38% of standard patients had a cerebral performance category of 1 or 2 at 30 days (P=0.6). Conclusions While the proportion of subjects reaching target temperature within 4 hours was not significantly different, the Arctic Sun cooled patients to a temperature of 34° C more rapidly than standard cooling blankets. Trial Registration ClinicalTrials.gov NCT00282373, registered January 24, 2006.

Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest

“…[5][6][7][10][11][12][13] The primary end point evaluated in the 2 small, randomized, controlled trials comparing advanced surface cooling pads and endovascular or basic surface cooling was the proportion of patients reaching the TT and the efficacy evaluated by the neuron-specific enolase levels but not survival. 14,15 Finally, multiple available cooling devices can be used alone or in combination. 5,6 To date, human studies have not demonstrated a clear clinical impact of early cooling associated with a strict maintenance phase of TH.…”

“…5,6 To date, human studies have not demonstrated a clear clinical impact of early cooling associated with a strict maintenance phase of TH. 10,11,[14][15][16][17][18][19][20][21][22][23] Because endovascular cooling seems faster and more accurate than other available methods, 8,[11][12][13][14]24 the aim of the present study was to determine the clinical impact of advanced core endovascular cooling versus basic surface cooling after OHCA from a presumed cardiac cause in a multicenter, randomized, controlled trial.…”

Part 8: Advanced Life Support

“…Nineteen studies indicated that cooling could be initiated safely with IV ice-cold fluids (30 mL/kg of saline 0.9% or Ringer's lactate) (LOE 3 748,749,825,831,833,837 ; LOE 4 779,780,782-785,810,836,838 -843 ). Six studies indicated that cooling with IV cold saline can be initiated in the prehospital phase (LOE 1 781,844 ; LOE 2 845 ; LOE 3 261,846 748,841,850,[853][854][855]. Seven studies documented the use of ice packs (sometimes combined with wet towels) alone to induce and maintain hypothermia (LOE 2 823 ; LOE 3 824,828,830 ; LOE 4 847,849,856 ).…”

Therapeutic Hypothermia for Acute Neurological Injuries

“…In a retrospective study by Merchant et al [71] of 32 patients in 3 large centers who underwent surface cooling using a mattress/blanket or ice bag, 63% of patients had temperature less than 32°C for more than 1 h. Temperature fluctuations also occurred throughout both the induction and ADH 0 xxxxx; IV 0 intravenous maintenance phases. This phenomenon has been consistently demonstrated in subsequent studies comparing different cooling methods [72][73][74]. Fans, washing the patient with alcohol baths, and ice immersions should not be used, as they are unpractical in the intensive care unit setting and ineffective for the maintenance and rewarming phases [3].…”