pre-hospital cooling of patients following cardiac arrest is effective using even low volumes of cold saline冷却后的患者院前心脏骤停是有效利用甚至低量的冷盐水.pdfVIP

Škulec et al. Critical Care 2010, 14:R231 /content/14/6/R231 RESEARCH Open Access Pre-hospital cooling of patients following cardiac arrest is effective using even low volumes of cold saline 1,2,3* 2,4 5 2 2,6 Roman Škulec , Anatolij Truhlář , Jana Šeblová , Pavel Dostál , Vladimír Černý Abstract Introduction: Pre-hospital induction of therapeutic mild hypothermia (TH) may reduce post-cardiac arrest brain injury in patients resuscitated from out-of-hospital cardiac arrest. Most often, it is induced by a rapid intravenous administration of as much as 30 ml/kg of cold crystalloids. We decided to assess the pre-hospital cooling effectivity of this approach by using a target dose of 15-20 ml/kg of 4°C cold normal saline in the setting of the physician- staffed Emergency Medical Service. The safety and impact on the clinical outcome have also been analyzed. Methods: We performed a prospective observational study with a retrospective control group. A total of 40 patients were cooled by an intravenous administration of 15-20 ml/kg of 4°C cold normal saline during transport to the hospital (TH group). The pre-hospital decrease of tympanic temperature (TT) was analyzed as the primary endpoint. Patients in the control group did not undergo any pre-hospital cooling. Results: In the TH group, administration of 12.6 ± 6.4 ml/kg of 4°C cold normal saline was followed by a pre- hospital decrease of TT of 1.4 ± 0.8°C in 42.8 ± 19.6 min (p 0.001). The most effective cooling was associated with a transport time duration of 38-60 min and with an infusion of 17 ml/kg of cold saline. In the TH group, a trend toward a reduced need for catecholamines during transport was detected (35.0 vs. 52.5%, p = 0.115). There were no dif