Pre-ROSC Intra-Nasal Cooling Effectiveness: A Randomized Study


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Animal studies suggest a life-saving benefit for intra-arrest cooling. No human studies to date have demonstrated an effective, practical method. Trans-nasal evaporative cooling has sufficient heat transfer capacity for effective intra-arrest cooling and improves survival in swine.


To study the safety and feasibility of trans-nasal cooling in the pre-hospital setting and determine effects on neurologically intact survival to hospital discharge from the addition of intra-arrest transnasal cooling compared to hospital-based cooling alone.


200 patients in witnessed cardiac arrest with CPR ≤20 minutes were randomized to intra-arrest trans-nasal cooling (treatment) versus standard ACLS care (control) in 15 European EMS systems. Trans-nasal cooling (RhinoChill®, BeneChill Inc. San Diego, CA) was initiated using a mixture of volatile coolant plus oxygen for rapid evaporative heat transfer. In treatment patients, cooling was initiated as soon as feasible without interfering with ACLS protocols, during ongoing CPR. Patients in both groups were cooled upon hospital arrival.


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Intra-arrest trans-nasal cooling is safe and feasible in the pre-hospital setting and significantly lowers tympanic and core temperature upon arrival at hospital. Survival to discharge and neurologically intact survival is significantly improved in witnessed arrests where CPR is initiated ≤10 minutes of collapse.

View the abstract from this study.

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