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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents the final results from a randomized trial evaluating prehospital cooling for patients resuscitated from cardiac arrest and showed that prehospital cooling did not improve survival or outcomes compared with standard cooling procedures [Kim F et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EFrancis Kim, MD, University of Washington, Seattle, Washington, USA, presented the final results from a randomized trial evaluating prehospital cooling for patients resuscitated from cardiac arrest and showed that prehospital cooling did not improve survival or outcomes compared with standard cooling procedures [Kim F et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAlthough therapeutic hypothermia has been shown to significantly reduce mortality and improve neurologic outcomes in cardiac arrest survivors, its optimal timing is unknown. This randomized clinical trial was designed to evaluate whether prehospital cooling in cardiac arrest patients, with and without ventricular fibrillation (VF), would reduce adverse clinical outcomes after resuscitation, compared with cooling that was initiated upon arrival in the emergency room.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ETo be included in the trial, patients had to have return of spontaneous circulation (ROSC), tracheal intubation, intravenous access, unconsciousness, and successful esophageal temperature probe placement. Patients with traumatic cardiac arrest, aged \u0026lt;18 years, temperature \u0026lt;34\u00b0C, mental status that was awake and following commands were excluded. The primary endpoints of the study were survival and neurological status at hospital discharge.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EA total of 1359 patients were enrolled in the study and randomized to standard care with or without prehospital cooling with an infusion of up to 2 L of 4\u00b0C normal saline as soon as possible after ROSC. Of these, there were 583 patients with VF (292 assigned to prehospital cooling and 291 to control) and 776 patients without VF (396 assigned to prehospital cooling and 380 to control).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EMean temperature at randomization was \u223c36\u00b0C and prehospital cooling significantly lowered temperature at hospital arrival (\u22121.2\u00b0C vs \u22120.1\u00b0C for VF patients; \u22121.3\u00b0C vs \u22120.1\u00b0C for non-VF patients; p\u0026lt;0.0001 for both) compared with standard care. Patients randomized to prehospital cooling achieved a goal temperature by 4.2 hours, compared with 5.5 hours in those patients treated with hospital cooling alone (p\u0026lt;0.001).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe primary endpoint of survival to hospital discharge was similar between the prehospital cooling and hospital-only cooling groups (62.7% vs 64.3%; p=0.69 for VF; 19.2% vs 16.3%; p=0.30 for non-VF).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EAdditionally, prehospital cooling did not improve neurologic outcomes for either patients with VF (57.5% experienced full recovery or mild impairment vs 61.9% of controls; p=0.69) or for those with non-VF (14.4% vs 13.4%; p=0.30; Figure 2) compared with cooling at hospital arrival.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ERe-arrest following randomization was also higher in the prehospital cooling arm (26% vs 21%; p=0.008). And upon hospital arrival, patients who received prehospital cooling had an increased incidence of pulmonary edema on chest x-ray (41% vs 30%; p\u0026lt;0.001) and requirement for diuretics in the first 12 hours of arrival (18% vs 13%; p=0.009).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EDr. Kim concluded that while prehospital cooling in cardiac arrest patients did reduce core temperature by hospital arrival, it did not improve outcomes in patients with and without VF when compared with hospital-only cooling. He also noted that since prehospital cooling increased the incidence of re-arrest, pulmonary edema on first chest x-ray, and need for diuretics, its routine use is not advocated in cardiac arrest patients.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/20\/14.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznjde\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}