Feasibility of external cranial cooling during out-of-hospital cardiac arrest

Callaway, Clifton W.; Tadler, Scott C.; Katz, Laurence M.; Lipinski, Christopher L; Brader, E

doi:10.1016/s0300-9572(01)00462-2

Cited by 81 publications

(67 citation statements)

References 27 publications

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“…One small feasibility trial was not included. 219 All 7 trials suffered from the unavoidable lack of blinding of the clinical team, and 3 also failed to blind the outcomes assessors.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

Self Cite

557

125

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Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

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“…One small feasibility trial was not included. 219 All 7 trials suffered from the unavoidable lack of blinding of the clinical team, and 3 also failed to blind the outcomes assessors.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

Self Cite

557

125

View full text Add to dashboard Cite

show abstract

“…[61] There was no difference in the rate of cooling in this study. Virkkunen et al, in 2004 reported a feasibility study using post ROSC infusion of 30 ml/kg LVICF after ROSC.…”

Section: Human Studiesmentioning

confidence: 52%

“…[54] Polderman, et al, used in addition to surface cooling, 30ml/kg (mean 2.3 liters) of cold normal saline over 50 minutes that showed similar results. [55] Several small randomized trials [56][57][58][59] , and nonrandomized observational and retrospective trials [60][61][62][63][64][65][66] , looked at pre-hospital cooling initiation for patients with OHCA.…”

Section: Human Studiesmentioning

confidence: 99%

Prehospital Therapeutic Hypothermia for Cardiac Arrest

Sadaka¹

2013

Therapeutic Hypothermia in Brain Injury

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“…The cooling rate of these devices ranged from 0.25 to 1.2°C ⁄ hour. The use of ice bags is labor intensive, 29 and might result in unintentional overcooling. 30 The infusion of cold crystalloids in the hospital proved to be well tolerated and feasible for induction of mild hypothermia, [31][32][33][34] but might be limited by cooling capacity 32,34 and is contraindicated in patients with pulmonary edema.…”

Section: Discussionmentioning

confidence: 99%

Surface Cooling for Rapid Induction of Mild Hypothermia After Cardiac Arrest: Design Determines Efficacy

Uray

Haugk

Sterz

et al. 2010

Academic Emergency Medicine

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Objectives: Recently, a novel cooling pad was developed for rapid induction of mild hypothermia after cardiac arrest. The aim of this study was to evaluate the cooling efficacy of three different pad designs for in-hospital cooling.Methods: Included in this prospective interventional study were patients with esophageal temperature (Tes) > 34°C on admission. The cooling pad consists of multiple cooling units, filled with a combination of graphite and water, which is precooled to -18°C (design A) or to -9°C (designs B and C) before use. The designs of the cooling pad differed in number, shape, and thickness of the cooling units, with weights of 9.7 kg (design A), 5.3 kg (design B), and 6.2 kg (design C). All three designs were tested in sequential order and were changed according to the results found in the previous trial. Cooling was started after admission until Tes = 34°C, when the cooling pad was removed. The target temperature of Tes = 32-34°C was maintained for 24 hours. Data are presented as medians and interquartile ranges (IQRs = 25%-75%) or proportions.Results: Cooling rates were 3.4°C ⁄ hour (IQR = 2.5-3.7) with design A (n = 12), 2.8°C ⁄ hour (IQR = 1.6-3.3) with design B (n = 7), and 2.9°C ⁄ hour (IQR = 1.9-3.6) with design C (n = 10; p = 0.5). To reach 34°C, the cooling pad had to be exchanged with a new one due to melting and therefore depleting cooling capacity in three patients with design A, in five patients with design B, and in no patient with design C (p = 0.004). Conclusions:With adequate design and storage temperature, the cooling pad proved to be efficient for rapid in-hospital cooling of patients resuscitated from cardiac arrest.

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Feasibility of external cranial cooling during out-of-hospital cardiac arrest

Cited by 81 publications

References 27 publications

Part 4: Advanced Life Support

Part 4: Advanced Life Support

Prehospital Therapeutic Hypothermia for Cardiac Arrest

Surface Cooling for Rapid Induction of Mild Hypothermia After Cardiac Arrest: Design Determines Efficacy

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