A Comprehensive Combination Method for Cooling Induction After Cardiac Arrest: A Clinical Feasibility Study

Kim, Hyo Joon; Kim, Young Min; Kim, Soo Hyun; Youn, Chun Song; Oh, Sang Hoon; Kim, Hyun Jung; Park, Kyu Nam

Abstract

PURPOSE
To evaluate the cooling efficacy and safety of a comprehensive combination method for cooling induction in post-cardiac arrest patients.
METHODS
Adult out-of-hospital cardiac arrest (OHCA) patients cooled using combination methods in a tertiary teaching hospital from January 2009 to June 2011were enrolled in the study. Patients were placed into one of two groups: 1) a typical combination (combination I) group, in which cold saline infusion, ice bags,and endovascular cooling were applied, and 2) acomprehensive combination (combination II) group, in which cold saline infusion, ice bags, endovascular cooling, skin exposure, and fanning with ice-water massage were applied. The time from cardiac arrest, return of spontaneous circulation (ROSC), and cooling start to 34degrees C, as well asadverse events during cooling, were recorded.
RESULTS
Forty-two out of 125(34%) of OHCA patients with ROSC were cooled usingcombination methods. There were no differences in baseline characteristics between the two combination groups. The time [median (IQR)] from arrest, ROSC, and cooling to 34degrees C of the combination II group were significantly shorter than those of the combination I group [215 min(range 156~270 min) vs. 320 min (range 263-385) for median IQR, p=.002; 189 min (range 135-220 min) vs. 288 min (range 227-358 min) for ROSC, p=.002; 150min (range 120-180 min) vs. 210 min (range 180-260 min) for cooling to 34degrees C, p=.030, respectively]. There were no statistical differences in adverse events during and after cooling induction between the two groups.
CONCLUSION
A comprehensive combination cooling method is feasible and capable of reducing the induction time for endovascular cooling in post-cardiac arrest patients.