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ID 53856
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Author
Kawashima, Takahisa
Kiyota, Kazuya
Oda, Shigeto
Morimoto, Naoki
Kobata, Hitoshi
Isobe, Hisashi
Honda, Mitsuru
Fujimi, Satoshi
Onda, Jun
I, Seishi
Sakamoto, Tetsuya
Ishikawa, Masami
Nakano, Hiroshi
Sadamitsu, Daikai
Kishikawa, Masanobu
Kinoshita, Kosaku
Yokoyama, Tomoharu
Harada, Masahiro
Kitaura, Michio
Ichihara, Kiyoshi
Hashimoto, Hiroshi
Tsuji, Hidekazu
Nagano, Osamu
Katayama, Hiroshi
Ujike, Yoshihito
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.
Keywords
Brain ischaemia
Cardiac arrest
Intra-arrest cooling
Pharynx
Selective cooling
Therapeutic hypothermia
Note
This is an open access article under the CC BY-NC-ND license
Published Date
2014-12
Publication Title
Resuscitation
Volume
volume85
Issue
issue12
Publisher
Elsevier Ireland Ltd.
Start Page
1647
End Page
1653
ISSN
0300-9572
NCID
AA00817253
Content Type
Journal Article
Official Url
http://dx.doi.org/10.1016/j.resuscitation.2014.09.014
Related Url
http://ousar.lib.okayama-u.ac.jp/metadata/53855
language
英語
Copyright Holders
Copyright © 2014 The Authors
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Refereed
True
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