How to give cold saline in the field

Pre-hospital therapeutic hypothermia might be a good thing, but there may be difficulties in achieving it if the 4 degrees C saline warms up during the infusion. What’s the optimal way of administering it? Czech investigators attempt to answer the question:

Background The cooling efficacy of intravenous administration of cold crystalloids can be enhanced by optimisation of the procedure. This study assessed the temperature stability of different application regimens of cold normal saline (NS) in simulated prehospital conditions.

Methods Twelve different application regimens of 4°C cold NS (volumes of 250, 500 and 1000 ml applied at infusion rates of 1000, 2000, 4000 and 6000 ml/h) were investigated for infusion temperature changes during administration to an artificial detention reservoir in simulated prehospital conditions.

Results An increase in infusion temperature was observed in all regimens, with an average of 8.163.38C (p<0.001). This was most intense during application of the residual 20% of the initial volume. The lowest rewarming was exhibited in regimens with 250 and 500 ml bags applied at an infusion rate of 6000 ml/h and 250 ml applied at 4000 ml/h. More intense, but clinically acceptable, rewarming presented in regimens with 500 and 1000 ml bags administered at 4000 ml/h, 1000 ml at 6000 ml/h and 250 ml applied at 2000 ml/h. Other regimens were burdened by excessive rewarming.

Conclusion Rewarming of cold NS during application in prehospital conditions is a typical occurrence. Considering that the use of 250 ml bags means the infusion must be exchanged too frequently during cooling, the use of 500 or 1000 ml NS bags applied at an infusion rate of $4000 ml/h and termination of the infusion when 80% of the infusion volume has been administered is regarded as optimal.

Prehospital cooling by cold infusion: searching for the optimal infusion regimen
Emerg Med J. 2010 Aug 23. [Epub ahead of print]