Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room

Yoshimasa Takeda, Takahisa Kawashima, Kazuya Kiyota, Shigeto Oda, Naoki Morimoto, Hitoshi Kobata, Hisashi Isobe, Mitsuru Honda, Satoshi Fujimi, Jun Onda, Seishi I, Tetsuya Sakamoto, Masami Ishikawa, Hiroshi Nakano, Daikai Sadamitsu, Masanobu Kishikawa, Kosaku Kinoshita, Tomoharu Yokoyama, Masahiro Harada, Michio KitauraKiyoshi Ichihara, Hiroshi Hashimoto, Hidekazu Tsuji, Takashi Yorifuji, Osamu Nagano, Hiroshi Katayama, Yoshihito Ujike, Kiyoshi Morita

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Aim: Cooling the pharynx and upper oesophagus would be more advantageous for rapid induction of therapeutic hypothermia since the carotid arteries run in their vicinity. The aim of this study was to determine the effects of pharyngeal cooling on brain temperature and the safety and feasibility for patients under resuscitation. Methods: Witnessed non-traumatic cardiac arrest patients (n=108) were randomized to receive standard care with (n=53) or without pharyngeal cooling (n=55). In the emergency room, pharyngeal cooling was initiated before or shortly after return of spontaneous circulation by perfusing physiological saline (5. °C) into a pharyngeal cuff for 120. min. Results: There was a significant decrease in tympanic temperature at 40. min after arrival (P=0.02) with a maximum difference between the groups at 120. min (32.9. ±. 1.2. °C, pharyngeal cooling group vs. 34.1. ±. 1.3. °C, control group; P<. 0.001). The return of spontaneous circulation (70% vs. 65%, P=0.63) and rearrest (38% vs. 47%, P=0.45) rates were not significantly different based on the initiation of pharyngeal cooling. No post-treatment mechanical or cold-related injury was observed on the pharyngeal epithelium by macroscopic observation. The thrombocytopaenia incidence was lower in the pharyngeal cooling group (P=0.001) during the 3-day period after arrival. The cumulative survival rate at 1 month was not significantly different between the two groups. Conclusions: Initiation of pharyngeal cooling before or immediately after the return of spontaneous circulation is safe and feasible. Pharyngeal cooling can rapidly decrease tympanic temperature without adverse effects on circulation or the pharyngeal epithelium.

Original languageEnglish
Pages (from-to)1647-1653
Number of pages7
JournalResuscitation
Volume85
Issue number12
DOIs
Publication statusPublished - Dec 1 2014

Keywords

  • Brain ischaemia
  • Cardiac arrest
  • Intra-arrest cooling
  • Pharynx
  • Selective cooling
  • Therapeutic hypothermia

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Takeda, Y., Kawashima, T., Kiyota, K., Oda, S., Morimoto, N., Kobata, H., Isobe, H., Honda, M., Fujimi, S., Onda, J., I, S., Sakamoto, T., Ishikawa, M., Nakano, H., Sadamitsu, D., Kishikawa, M., Kinoshita, K., Yokoyama, T., Harada, M., ... Morita, K. (2014). Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room. Resuscitation, 85(12), 1647-1653. https://doi.org/10.1016/j.resuscitation.2014.09.014