Pre-hospital therapeutic hypothermia

A Czech study demonstrated effective pre-hospital therapeutic cooling of post-cardiac arrest patients using fairly modest amounts of intravenous saline at 4°C: the administration of 12.6 ± 6.4 mL/kg (1,032 ± 546 mL) of 4°C normal saline led to a tympanic temperature decrease of 1.4 ± 0.8°C (from 36.2 ± 1.5 to 34.7 ± 1.4°C; P < 0.001) in 42.8 ± 19.6 minutes. No ice packs were applied.

Before other emergency medical services adopt this, it should be noted that all these patients were managed in the field by emergency physicians who administered sedatives and neuromuscular blockers. It’s a European thing.

Pre-hospital cooling of patients following cardiac arrest is effective using even low volumes of cold saline
Critical Care 2010, 14:R231 Full text

3 thoughts on “Pre-hospital therapeutic hypothermia”

  1. Hi Cliff
    You may already be aware but this treatment modality is not entirely a European thing (the physician thing is). Victorian MICA paramedics have been utilizing therapeutic hypothermia in the post-arrest patient for some years now, using pancuronium and a morphine/midazolam infusion for eliminating shivering and maintaining sedation. Coupled with aggressive haemodynamic management with pressors/inotropes as required they seem to have an above average rate of survival to discharge for patients presenting in VT/VF (~10%)

    Thanks for the hard work keeping us up to date with everything emergency, your site is a godsend for those of us who struggle to wade through all the studies that come out evey month.

  2. Thanks Ambo Driver – agree it’s not REALLY just a European thing – I am after all a pre-hospital critical care physician in Australia!

    The MICA pre-hospital therapeutic hypothermia trial was blogged here http://www.resusme.em.extrememember.com/?p=2787

    Thanks for the great feedback – glad the site is useful for you guys too.

    Cliff

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