A review of the pre-ROSC intranasal cooling effectiveness study

Abstract

With the publication of the 2010 European Resuscitation Council Guidelines, therapeutic hypothermia has been recommended as part of the treatment algorhythm for the management of adult cardiac arrest. As ambulance services around the world struggle to decide on the best method of cooling a patient at the time of the return of spontaneous circulation (ROSC), the ground-breaking ‘PRINCE’ study has been published describing the novel approach of ‘trans-nasal’ evaporative cooling during the peri-arrest period. This study describes a significant difference found on arrival at hospital between the mean tympanic temperatures of the two groups (cooled vs control) following a period of cooling (34.2 °C [SD 1.5 °C] vs 35.5 °C [SD 0.9 °C], P<0.001). In addition, when looking at survival to discharge following out-of-hospital (OOH) cardiac arrest, there was a statistically significant difference in a subgroup of patients where CPR was commenced within 10 minutes of cardiac arrest (56.5% of trans-nasally cooled patients survived to discharge compared with 29.4% of control patients (P=0.04, relative risk =1.9)). This article examines the PRINCE study and considers the implication of this method of inducing therapeutic hypothermia in the out-of-hospital cardiac arrest patient within the UK.