Per Nordberg, MD, PhD, Principal Investigator

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Presentation transcript:

Per Nordberg, MD, PhD, Principal Investigator Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden Disclosures: Grants from Swedish Heart and Lung Foundation and Laerdal Foundation Cooling device provided without cost, BrainCool AB

Hypothermia in cardiac arrest protects the brain Animal data shows that ”the earlier, the better” Most studies are based on hospital cooling Prehospital cooling with cold fluids is not hemodynamically safe CARDIAC ARREST

TRANSNASAL EVAPORATIVE COOLING Primarily brain cooling Easy to use, early initiation Non-invasive Continuous cooling No volume load

To study the effect of intra-arrest, trans-nasal evaporative cooling on neurologic intact survival in out-of-hospital cardiac arrest patients. Primary outcome was survival with CPC 1-2 at 90 days

Study period 2010-2018

Ventricular fibrillation Inclusion criteria Bystander witnessed cardiac arrest Age ≥18 years Exclusion criteria Age ≥80 years Obvious non-cardiac cause A barrier to place intra nasal catheters DNAR orders Achieve ROSC prior to randomization Response time of EMS > 15 minutes Predefined subgroup: Ventricular fibrillation

CONTROL INTERVENTION Absolute difference 3.1%, relative difference 23%

45/138 27/135 50/337 35/334

NEUROLOGIC OUTCOMES, CPC 1-4 NUMBER OF PATIENTS ALIVE AT 90 DAYS CPC 1 n=50 n=60 CPC 1 n=35 n=52

TIME TO COOLING AND NEUROLOGIC OUTCOME ALL PATIENTS / PATIENTS WITH VF MEDIAN TIME TO COOLING 19 MINUTES Survival with CPC 1-2 at 90 days, VF patients Time from collapse to intra-arrest cooling

CONCLUSIONS TRANSNASAL EVAPORATIVE COOLING IN OUT-OF-HOSPITAL CARDIAC ARREST HEMODYNAMICALLY SAFE SIGNIFICANTLY SHORTENED TIME TO TARGET TEMPERATURE THE DIFFERENCE IN PRIMARY OUTCOME (CPC 1-2) WAS NOT STATISTICALLY SIGNIFICANT TREND TOWARDS IMPROVED NEUROLOGIC OUTCOME IN PATIENTS WITH VENTRICULAR FIBRILLATION SIGNIFICANTLY IMPROVED COMPLETE RECOVERY (CPC 1) IN PATIENTS WITH VENTRICULAR FIBRILLATION

Email: per.nordberg@sll.se A special Thanks to: Leif Svensson Fabio Silvio Taccone Anatolij Truhlar Jacob Hollenberg Sune Forsberg Thomas Hermansson Anders Bäckman Martin Jonsson Email: per.nordberg@sll.se