• Cédric Bruel, Jean-Jacques Parienti, William Marie, Xavier Arrot, Cédric Daubin, Damien Du Cheyron, Massimo Massetti, and Pierre Charbonneau.
• Medical Intensive Care Unit, Caen University Hospital, Avenue côte de Nacre, 14033 Caen cedex, France. ced.bruel@laposte.net
• Crit Care. 2008 Jan 1;12(1):R31.

IntroductionInduction of mild hypothermia after cardiac arrest may confer neuroprotection. We assessed the feasibility, safety and effectiveness of therapeutic infusion of 2 l of normal saline at 4 degrees C before return of spontaneous circulation during cardiopulmonary resuscitation after out of hospital cardiac arrest.MethodsThis was a prospective, observational, multicenter clinical trial conducted in Emergency Medical Services units and in a medical intensive care unit at Caen University Hospital, Cen, France.ResultsIn patients who had suffered out of hospital cardiac arrest, hypothermia was induced by infusing 2 l of 4 degrees C NaCl 0.9% over 30 minutes during advanced life support prior to arrival at the hospital. A total of 33 patients were included in the study. Eight patients presented with ventricular fibrillation as the initial cardiac rhythm. Mild hypothermia was achieved after a median of 16 minutes (interquartile range 11.5 to 25.0 minutes) after return of spontaneous circulation. After intravenous cooling, the temperature decreased by 2.1 degrees C (P < 0.0001) to a mean body temperature of 33.3 degrees C (interquartile range 32.3 to 34.3 degrees C). The only observed adverse event was pulmonary oedema, which occurred in one patient.ConclusionWe concluded that prehospital induction of therapeutic hypothermia using infusion of 2 l of 4 degrees C normal saline during advanced life support was feasible, effective and safe. Larger studies are required to assess the impact that this early cooling has on neurological outcomes after cardiac arrest.

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