Intra-Nasal Cooling During Resuscitation May Save More Brains After Cardiac Arrest

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Main Category: Medical Devices / Diagnostics
Also Included In: Cardiovascular / Cardiology;  Neurology / Neuroscience
Article Date: 16 Nov 2009 - 9:00 PDT

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A new study involving emergency centres in Europe found that using a new portable device in situ to spray a rapidly evaporating coolant into the nasal cavity within minutes of the heart arresting resulted in faster and earlier cooling and a higher chance of saving the brain of patients compared to waiting until they are in the emergency room (ER).

Dr Maaret Castren of the Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden, and lead investigator of the Pre-Resuscitation Intra-Nasal Cooling Effectiveness (PRINCE) study, presented the study results to delegates attending the American Heart Association (AHA) Resuscitation Science Symposium on Sunday November 15th in Orlando, Florida.

Castren, who is also from the Department of Emergency Medicine, Sodersjukhuset, told the media that:

"In this study, early cooling of the brain combined with early CPR [cardiopulmonary resuscitation] favorably affected outcomes, irrespective of rhythm."

"We believe that this study demonstrates that making every attempt to initiate both CPR and intra-arrest cooling as early as possible in the resuscitation process should be adopted," she urged.

The PRINCE study involved nearly 200 patients admitted to 15 Emergency Medical Systems (EMS) in Belgium, Germany, Italy, Czech Republic and Sweden.

The aim of the study was to determine safety and efficacy of intra-nasal cooling during ongoing resuscitation of cardiac arrest patients even before the return of circulation (ROSC).

For the study, the researchers used a commercial device called RhinoChill, a non-invasive nasal catheter that sprays the rapidly evaporating coolant liquid straight into the nasal cavity, which acts like a large heat exchanger right next to the brain.

The device is made by BeneChill of San Diego, California, who also sponsored the research. The idea of RhinoChill is to enable cooling to start much earlier than conventional methods which can only start once the patient is in a hospital setting.

It also focuses on the brain, because as Dr Denise Barbut, founder and CEO of BeneChill explained:

"The brain is the organ that dies first so the closer to the time of arrest the brain is cooled, the more of it is rescued."

"The brain is the organ that controls the heart, much like a puppet on a string," she added.

The PRINCE researchers looked at measures like cooling rates, time to achieve the target temperature, how easy the device was to use in the field, ROSC rates, survival and neurologically intact survival.

The 182 participants were recruited on the basis that they were over 18 years old and in cardiac arrest and not hospitalized during resuscitation. Of these 83 were treated with nasal cooling and 99 received standard care.

Patients deemed eligible for advance cardiac life support (ACLS) were included as long as the arrest was witnessed and CPR was started within 20 minutes of collapse.

The results showed that:

• Cooling was started for a median of 23 minutes following arrest and lowered brain temperature (tympanic) and body temperature significantly by the time patients arrived at the ER.


• Time to target tympanic temperature of 34 degrees was 3 hours faster and time to target core body temperature 2 two hours faster in patients treated with intra-nasal coolant in the field compared to those receiving standard care in the hospital.


• Survival to discharge was higher among patients receiving nasal cooling compared to those receiving standard care (46.7 per cent compared to 31 per cent).


• Neurologically intact survival to discharge was also higher among patients receiving nasal cooling compared to those receiving standard care (36.7 versus 21.4 per cent).


• Where CPR started within 10 minutes of cardiac arrest, survival to discharge was significantly higher among patients receiving nasal cooling (59.1 per cent) than among patients receiving standard care (29.4 per cent), and neurologically intact survival was also signficantly higher (45.5 versus 17.6 per cent).

The researchers concluded that intra-nasal cooling was feasible and safe during an arrest. The most commonly reproted adverse event was nasal discoloration, which occurred in 13 patients and resolved spontaneously in all patients who were successfully rescuscitated, according to a press release from BeneChill.

The EMS staff commented that the device's portability meant it was easy to use and coolant could be administered in the field by non-specialized medical staff.

Source: BeneChill via PR Newswire.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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