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Feasibility of intra-arrest hypothermia induction: A novel nasopharyngeal
approach achieves preferential brain cooling
#MMPMID20538402
Boller M
; Lampe JW
; Katz JM
; Barbut D
; Becker LB
Resuscitation
2010[Aug]; 81
(8
): 1025-30
PMID20538402
show ga
AIM: In patients with cardiopulmonary arrest, brain cooling may improve
neurological outcome, especially if applied prior to or during early reperfusion.
Thus it is important to develop feasible cooling methods for pre-hospital use.
This study examines cerebral and compartmental thermokinetic properties of
nasopharyngeal cooling during various blood flow states. METHODS: Ten swine
(40+/-4kg) were anesthetized, intubated and monitored. Temperature was determined
in the frontal lobe of the brain, in the aorta, and in the rectum. After the
preparatory phase the cooling device (RhinoChill system), which produces
evaporative cooling in the nasopharyngeal area, was activated for 60min. The
thermokinetic response was evaluated during stable anaesthesia (NF, n=3); during
untreated cardiopulmonary arrest (ZF, n=3); during CPR (LF, n=4). RESULTS:
Effective brain cooling was achieved in all groups with a median cerebral
temperature decrease of -4.7 degrees C for NF, -4.3 degrees C for ZF and -3.4
degrees C for LF after 60min. The initial brain cooling rate however was fastest
in NF, followed by LF, and was slowest in ZF; the median brain temperature
decrease from baseline after 15min of cooling was -2.48 degrees C for NF, -0.12
degrees C for ZF, and -0.93 degrees C for LF, respectively. A median aortic
temperature change of -2.76 degrees C for NF, -0.97 for LF and +1.1 degrees C for
ZF after 60min indicated preferential brain cooling in all groups. CONCLUSION:
While nasopharyngeal cooling in swine is effective at producing preferential
cerebral hypothermia in various blood flow states, initial brain cooling is most
efficient with normal circulation.
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