Prehospital cooling with hypothermia caps (PreCoCa): a feasibility study

  • Christian Storm
  • Joerg C. Schefold
  • Thoralf Kerner
  • Willi Schmidbauer
  • Jola Gloza
  • Anne Krueger
  • Achim Jörres
  • Dietrich Hasper
ORIGINAL PAPER

Abstract

Background

Animal studies suggest that the induction of therapeutic hypothermia in patients after cardiac arrest should be initiated as soon as possible after ROSC to achieve optimal neuroprotective benefit. A “gold standard” for the method of inducing hypothermia quickly and safely has not yet been established. In order to evaluate the feasibility of a hypothermia cap we conducted a study for the prehospital setting.

Methods and results

The hypothermia cap was applied to 20 patients after out-of-hospital cardiac arrest with a median of 10 min after ROSC (25/75 IQR 8–15 min). The median time interval between initiation of cooling and hospital admission was 28 min (19–40 min). The median tympanic temperature before application of the hypothermia cap was 35.5°C (34.8–36.3). Until hospital admission we observed a drop of tympanic temperature to a median of 34.4°C (33.6–35.4). This difference was statistically significant (P < 0.001). We could not observe any side effects related to the hypothermia cap. 25 patients who had not received prehospital cooling procedures served as a control group. Temperature at hospital admission was 35.9°C (35.3–36.4). This was statistically significant different compared to patients treated with the hypothermia cap (P < 0.001).

Conclusions

In summary we demonstrated that the prehospital use of hypothermia caps is a safe and effective procedure to start therapeutic hypothermia after cardiac arrest. This approach is rapidly available, inexpensive, non-invasive, easy to learn and applicable in almost any situation.

Keywords

cardiac arrest therapeutic hypothermia prehospital cooling hypothermia cap 

Notes

Acknowledgments

We would like to thank the engaged contribution of the ambulance staff from the Notarztwagen 2505 and 1305. The Hypothermia Caps were provided from Southwest Technologies USA via Lievens-Lanckman BVBA, Belgium. There were no other financial relationships.

Conflict of interest The authors declare that there is no conflict of interest.

Criteria for authorship DH, CS and JCS designed and supervised the study from data acquisition to data analysis. WS, TK and JG participated in the design of the study. AK and AJ revised the manuscript for important intellectual content and helped draft the manuscript.

References

  1. 1.
    Arrich J (2007) Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med 35:1041–1047PubMedCrossRefGoogle Scholar
  2. 2.
    Frankenstein L, Zugck C, Nelles M, Schellberg D, Remppis A, Katus H (2008) Primary ICD-therapy in patients with advanced heart failure: selection strategies and future trials. Clin Res CardiolGoogle Scholar
  3. 3.
    Friedrich EB, Teo KK, Bohm M (2006) ACE inhibition in secondary prevention: are the results controversial? Clin Res Cardiol 95:61–67PubMedCrossRefGoogle Scholar
  4. 4.
    Hachimi-Idrissi S, Corne L, Ebinger G, Michotte Y, Huyghens L (2001) Mild hypothermia induced by a helmet device: a clinical feasibility study. Resuscitation 51:275–281PubMedCrossRefGoogle Scholar
  5. 5.
    Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484PubMedCrossRefGoogle Scholar
  6. 6.
    Kim F, Olsufka M, Longstreth WT Jr, Maynard C, Carlbom D, Deem S, Kudenchuk P, Copass MK, Cobb LA (2007) Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4°C normal saline. CirculationGoogle Scholar
  7. 7.
    Kim F, Olsufka M, Carlbom D, Deem S, Longstreth WT Jr, Hanrahan M, Maynard C, Copass MK, Cobb LA (2005) Pilot study of rapid infusion of 2 l of 4°C normal saline for induction of mild hypothermia in hospitalized, comatose survivors of out-of-hospital cardiac arrest. Circulation 112:715–719PubMedCrossRefGoogle Scholar
  8. 8.
    Mariak Z, White MD, Lyson T, Lewko J (2003) Tympanic temperature reflects intracranial temperature changes in humans. Pflugers Arch 446:279–284PubMedGoogle Scholar
  9. 9.
    Merchant RM, Soar J, Skrifvars MB, Silfvast T, Edelson DP, Ahmad F, Huang KN, Khan M, Vanden Hoek TL, Becker LB, Abella BS (2006) Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest. Crit Care Med 34:1935–1940PubMedCrossRefGoogle Scholar
  10. 10.
    Nolan JP, Morley PT, Hoek TL, Hickey RW (2003) Therapeutic hypothermia after cardiac arrest. An advisory statement by the advancement life support task force of the international liaison committee on Resuscitation. Resuscitation 57:231–235PubMedCrossRefGoogle Scholar
  11. 11.
    Nozari A, Safar P, Stezoski SW, Wu X, Kostelnik S, Radovsky A, Tisherman S, Kochanek PM (2006) Critical time window for intra-arrest cooling with cold saline flush in a dog model of cardiopulmonary resuscitation. Circulation 113:2690–2696PubMedCrossRefGoogle Scholar
  12. 12.
    Qiu W, Shen H, Zhang Y, Wang W, Liu W, Jiang Q, Luo M, Manou M (2006) Noninvasive selective brain cooling by head and neck cooling is protective in severe traumatic brain injury. J Clin Neurosci 13:995–1000PubMedCrossRefGoogle Scholar
  13. 13.
    Schefold JC, Storm C, Hasper D (2008) Prehospital therapeutic hypothermia in cardiac arrest: will there ever be evidence? Crit Care 12:413PubMedCrossRefGoogle Scholar
  14. 14.
    Simon T, Becker R, Voss F, Bikou O, Hauck M, Licka M, Katus HA, Bauer A (2008) Elevated B-type natriuretic peptide levels in patients with nonischemic cardiomyopathy predict occurrence of arrhythmic events. Clin Res CardiolGoogle Scholar
  15. 15.
    Storm C, Schefold JC, Nibbe L, Martens F, Krueger A, Oppert M, Joerres A, Hasper D (2006) Therapeutic hypothermia after cardiac arrest—the implementation of the ILCOR guidelines in clinical routine is possible! Crit Care 10:425PubMedCrossRefGoogle Scholar
  16. 16.
    Suffoletto BP, Salcido DD, Menegazzi JJ (2008) Use of prehospital-induced hypothermia after out-of-hospital cardiac arrest: a survey of the national association of emergency medical services physicians. Prehosp Emerg Care 12:52–56PubMedCrossRefGoogle Scholar
  17. 17.
    Tooley JR, Eagle RC, Satas S, Thoresen M (2005) Significant head cooling can be achieved while maintaining normothermia in the newborn piglet. Arch Dis Child Fetal Neonatal Ed 90:F262–F266PubMedCrossRefGoogle Scholar
  18. 18.
    Wang H, Olivero W, Lanzino G, Elkins W, Rose J, Honings D, Rodde M, Burnham J, Wang D (2004) Rapid and selective cerebral hypothermia achieved using a cooling helmet. J Neurosurg 100:272–277PubMedCrossRefGoogle Scholar
  19. 19.
    Wolfrum S, Radke PW, Pischon T, Willich SN, Schunkert H, Kurowski V (2007) Mild therapeutic hypothermia after cardiac arrest—a nationwide survey on the implementation of the ILCOR guidelines in German intensive care units. Resuscitation 72:207–213PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Christian Storm
    • 1
  • Joerg C. Schefold
    • 1
  • Thoralf Kerner
    • 2
  • Willi Schmidbauer
    • 3
  • Jola Gloza
    • 1
  • Anne Krueger
    • 1
  • Achim Jörres
    • 1
  • Dietrich Hasper
    • 1
  1. 1.Department of Nephrology and Medical, Intensive Care MedicineCharité Universitätsmedizin Berlin, Campus Virchow-KlinikumBerlinGermany
  2. 2.Department of Anaesthesiology and Intensive Care MedicineCharite Universitätsmedizin Berlin, Campus Virchow-KlinikumBerlinGermany
  3. 3.Department of AnaesthesiologyBundeswehrkrankenhaus BerlinBerlinGermany

Personalised recommendations