Abstract | BACKGROUND: METHODS AND RESULTS: In a prospective, randomized controlled trial, we assigned adults who had been resuscitated from out-of-hospital cardiac arrest with an initial cardiac rhythm of ventricular fibrillation to either prehospital cooling with a rapid infusion of 2 L of ice-cold lactated Ringer's solution or cooling after hospital admission. The primary outcome measure was functional status at hospital discharge, with a favorable outcome defined as discharge either to home or to a rehabilitation facility. A total of 234 patients were randomly assigned to either paramedic cooling (118 patients) or hospital cooling (116 patients). Patients allocated to paramedic cooling received a median of 1900 mL (first quartile 1000 mL, third quartile 2000 mL) of ice-cold fluid. This resulted in a mean decrease in core temperature of 0.8 degrees C (P=0.01). In the paramedic-cooled group, 47.5% patients had a favorable outcome at hospital discharge compared with 52.6% in the hospital-cooled group (risk ratio 0.90, 95% confidence interval 0.70 to 1.17, P=0.43). CONCLUSIONS: In adults who have been resuscitated from out-of-hospital cardiac arrest with an initial cardiac rhythm of ventricular fibrillation, paramedic cooling with a rapid infusion of large-volume, ice-cold intravenous fluid decreased core temperature at hospital arrival but was not shown to improve outcome at hospital discharge compared with cooling commenced in the hospital.
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Authors | Stephen A Bernard, Karen Smith, Peter Cameron, Kevin Masci, David M Taylor, D James Cooper, Anne-Maree Kelly, William Silvester, Rapid Infusion of Cold Hartmanns (RICH) Investigators |
Journal | Circulation
(Circulation)
Vol. 122
Issue 7
Pg. 737-42
(Aug 17 2010)
ISSN: 1524-4539 [Electronic] United States |
PMID | 20679551
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Topics |
- Aged
- Body Temperature
(physiology)
- Cardiopulmonary Resuscitation
(methods, trends)
- Emergency Medical Services
(methods, trends)
- Emergency Medical Technicians
(trends)
- Female
- Heart Arrest
(complications, physiopathology, therapy)
- Hospitalization
(trends)
- Humans
- Hypothermia, Induced
(methods, trends)
- Male
- Middle Aged
- Patient Discharge
(trends)
- Prospective Studies
- Treatment Outcome
- Ventricular Fibrillation
(complications, physiopathology, therapy)
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