Abstract 159: Immediate Transnasal Evaporative Cooling During Resuscitation from Cardiac Arrest: The Cool Before Airway Study

Abstract

BACKGROUND: Therapeutic hypothermia is an integral part of the standard resuscitation care. One method to induce therapeutic hypothermia is transnasal evaporative cooling. PURPOSE/AIMS: We wanted to demonstrate that transnasal evaporative cooling initiated prior to achieving a protected airway during CPR in an out-of-hospital setting is safe and feasible. METHODS: Transnasal evaporative cooling via the RhinoChill® (RC) System (BeneChill Inc. San Diego, CA, USA) was initiated prior to a protected airway after initiating cardiac resuscitation, and was continued until either the subject was declared dead, standard institutional systemic cooling methods were implemented or cooling equipment (oxygen and perfluorcarbone) was empty. The subject was monitored throughout the hypothermia period, and followed until either death or hospital discharge. Clinical assessments and clinically relevant adverse events were documented over this period of time. RESULTS: In total 21 patients were included in this trial. Four of them had to be excluded subsequently. One patient had been excluded due to a pre-existing secured airway, the others due to user errors. Finally, 17 patients (f=6; mean age 65.5 years, CI95%: 57.7-73.4) met all the eligibility criteria and were included for further investigation. Device-related adverse events occurred in only two patients, which were mild and had no consequence on the patient’s outcome. One was reversible nose-whitening and the other epistaxis. According to the filed reports of the EMS personnel, no severe technical problems occurred by using the RC device that led to a delay or the impairment of quality of the CPR. The most common observed interruption in the application was a short blockage of the device (n=12). In four cases the bag-valve-mask-ventilation wasn’t possible due to blockage or a sealing lack and in two cases a moderate orificial fluid spraying was observed during chest compressions. CONCLUSIONS/RECOMMENDATIONS: Early application of the RC device, during cardiac arrest in the out-of-hospital setting of Vienna, is feasible, safe and easy to handle and does not delay or hinder CPR, or establishment of a secure intubation. For efficacy and further safety data additional studies will be needed.