@article{c7cf207144ea41998fd03ecb9f6c31a1,
title = "Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room",
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.",
keywords = "Brain ischaemia, Cardiac arrest, Intra-arrest cooling, Pharynx, Selective cooling, Therapeutic hypothermia",
author = "Yoshimasa Takeda and Takahisa Kawashima and Kazuya Kiyota and Shigeto Oda and Naoki Morimoto and Hitoshi Kobata and Hisashi Isobe and Mitsuru Honda and Satoshi Fujimi and Jun Onda and Seishi I and Tetsuya Sakamoto and Masami Ishikawa and Hiroshi Nakano and Daikai Sadamitsu and Masanobu Kishikawa and Kosaku Kinoshita and Tomoharu Yokoyama and Masahiro Harada and Michio Kitaura and Kiyoshi Ichihara and Hiroshi Hashimoto and Hidekazu Tsuji and Takashi Yorifuji and Osamu Nagano and Hiroshi Katayama and Yoshihito Ujike and Kiyoshi Morita",
note = "Funding Information: The research was supported by a grant from the Ministry of Health, Labour and Welfare of Japan ( H19-trans-005 ) and by a grant from Daiken Medical Co. No sources of funding were involved in the study design; in the collection, analysis, and interpretation of the data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. Funding Information: Originally, the present study was financially supported by the Ministry of Health, Labour and Welfare of Japan and was intended to determine the effect of pharyngeal cooling on tympanic temperature. In July 2010, the institutional review board at Okayama University Medical School recommended discontinuation of this work because of the apparent decrease in tympanic temperature in the pharyngeal cooling group. In December 2011, after approval by the institutional review board, the research was resumed to examine the effect of pharyngeal cooling on survival with the same protocol and was supported by Daiken Medical Co. Although the sample size (108 cases) was much smaller than the size required to evaluate survival (692 cases), the study was terminated owing to the end of the planned experimental period. Publisher Copyright: {\textcopyright} 2014 The Authors.",
year = "2014",
month = dec,
day = "1",
doi = "10.1016/j.resuscitation.2014.09.014",
language = "English",
volume = "85",
pages = "1647--1653",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",
number = "12",
}