Use of ice-cold crystalloid for inducing mild therapeutic hypothermia following out-of-hospital cardiac arrest.

OBJECTIVE: Out of hospital cardiac arrest (OHCA) results in a significant mortality and neurological disability in survivors. The application of mild therapeutic hypothermia (MTH) to patients who have suffered an OHCA with a ventricular rhythm results in a significant reduction in mortality and neurological disability in survivors. The optimal timing of this intervention has not been clearly established; however there is emerging evidence to suggest that maximal benefit is gained from initiation at the earliest time point. Despite this, recent surveys have shown a considerable delay in initiating MTH, with variable uptake in emergency departments (EDs), where a number of impediments to delivery have been identified.
METHOD: We have reviewed the literature to determine what are the barriers to the initiation of MTH in the ED. We also reviewed the literature on the use of ice-cold crystalloids as a practical, simple, effective, and safe method to induce MTH.
RESULTS: Among the several reasons, the perception of a lack of a practical method and logistical constraints are cited as common barriers. However, the available literature on the use of ice-cold crystalloids suggests that this is a safe and effective method of inducing MTH.
CONCLUSION: ED staff need to be aware that the use of ice-cold fluids is an inexpensive, readily available and easy to perform method of inducing MTH in patients who suffer an out-of hospital cardiac arrest with a ventricular rhythm. We therefore suggest that ice-cold crystalloid is routinely stocked in emergency departments and, unless contraindicated, is used to induce MTH. Optimal post-resuscitation care also includes timely treatment of the cause of the OHCA and maintenance of MTH. Staff education and care bundles may help to facilitate optimal inter-departmental management of the patient.