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

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

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.