Yoshimasa Takeda1, Takahisa Kawashima2, Kazuya Kiyota3, Shigeto Oda4, Naoki Morimoto5, Hitoshi Kobata6, Hisashi Isobe7, Mitsuru Honda8, Satoshi Fujimi9, Jun Onda10, Seishi I11, Tetsuya Sakamoto12, Masami Ishikawa13, Hiroshi Nakano14, Daikai Sadamitsu15, Masanobu Kishikawa16, Kosaku Kinoshita17, Tomoharu Yokoyama18, Masahiro Harada19, Michio Kitaura20, Kiyoshi Ichihara21, Hiroshi Hashimoto22, Hidekazu Tsuji22, Takashi Yorifuji23, Osamu Nagano24, Hiroshi Katayama25, Yoshihito Ujike26, Kiyoshi Morita27. 1. Department of Anesthesiology, Okayama University Medical School, 2-5-1 Shikata-cho Kita-ku, Okayama 700-8558, Japan. Electronic address: yoshit@cc.okayama-u.ac.jp. 2. Department of Emergency and Critical Care Medicine, Iseikai Hospital, 6-2-25 Sugahara Higashiyodogawa-ku, Osaka 533-0022, Japan. 3. Tertiary Emergency Medical Center, Saitama Red-Cross Hospital, 8-3-33 Kamiochiai Chuo-ku, Saitama 338-0001, Japan. 4. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba 260-0856, Japan. 5. Emergency and Critical Care Center, Tsuyama Central Hospital, 1756 Kawasaki Tsuyama, Okayama 708-0841, Japan. 6. Osaka Mishima Emergency Critical Care Center, 11-1 Minamiakutagawacho Takatsuki, Osaka 569-1124, Japan. 7. Department of Emergency Diagnosis and Treatment, Himeji Medical Center, 68 Honmachi Himeji, Hyogo 670-0012, Japan. 8. Emergency and Critical Care Center, Toho University Faculty of Medicine, 5-21-16 Omorinishi Ota-ku, Tokyo 143-0015, Japan. 9. Critical Care and Trauma Center, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-ku, Osaka 558-0056, Japan. 10. Department of Neurosurgery, Kitakyushu Yugawa Hospital, 2-1-10 Kuzuhara Kitakyushu Kokuraminami-ku, Fukuoka 800-0251, Japan. 11. Department of Emergency Medicine, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamineminami Higashi-ku, Kumamoto 861-8039, Japan. 12. Trauma and Resuscitation Center, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-ku, Tokyo 173-0003, Japan. 13. Emergency Department, Kure Kyosai Hospital, 2-3-28 Nishichuo Kure, Hiroshima 737-0811, Japan. 14. Emergency Department, Okazaki City Hospital, 3-1 Goshoai Koryujicho, Okazaki, Aichi 444-0002, Japan. 15. Emergency and Critical Care Center, Osaka Medical Center, 2-1-14 Hoenzaka Chuo-ku, Osaka 540-0006, Japan. 16. Emergency and Critical Care Center, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin Chuo-ku, Fukuoka 810-0001, Japan. 17. Emergency and Critical Care Center, Nihon University Itabashi Hospital, 30 Oyaguchikamicho Itabashi-ku, Tokyo 173-0032, Japan. 18. Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo 193-0944, Japan. 19. Emergency and Critical Care Center, Kumamoto Medical Center, 1-5 Ninomaru Chuo-ku, Kumamoto 860-0008, Japan. 20. Department of Emergency and Critical Care Medicine, Kagawa Rosai Hospital, 3-3-1 Jotocho Marugame, Kagawa 763-0013, Japan. 21. Department of Clinical Laboratory Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi Ube, Yamaguchi 755-0046, Japan. 22. Daiken Medical Co., 3-6-1 Doshomachi Chuo-ku, Osaka 541-0045, Japan. 23. Department of Human Ecology, Okayama University Graduate School of Environmental and Life Science, 2-5-1 Shikata-cho Kita-ku, Okayama 700-8558, Japan. 24. Department of Disaster and Emergency Medicine, Kochi University Medical School, Okochokohasu Nankoku, Kochi 783-8505, Japan. 25. Department of Anesthesiology and Intensive Care Medicine, Kawasaki Medical School, 2-1-80 Nakasange Kita-ku, Okayama 700-0821, Japan. 26. Department of Emergency and Critical Care Medicine, Okayama University Medical School, 2-5-1 Shikata-cho Kita-ku, Okayama 700-8558, Japan. 27. Okayama University, 1-1-1 Tsushimanaka Kita-ku, Okayama 700-0082, Japan.
Abstract
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.
RCT Entities:
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 arrestpatients (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.
Authors: Lauren T Southerland; Katherine K Benson; Austin J Schoeffler; Margaret A Lashutka; Soo Borson; Jason J Bischof Journal: J Am Coll Emerg Physicians Open Date: 2022-07-29