start-ver=1.4 cd-journal=joma no-vol=85 cd-vols= no-issue=12 article-no= start-page=1647 end-page=1653 dt-received= dt-revised= dt-accepted= dt-pub-year=2014 dt-pub=201412 dt-online= en-article= kn-article= en-subject= kn-subject= en-title= kn-title=Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room en-subtitle= kn-subtitle= en-abstract= kn-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 } 1.2C, pharyngeal cooling group vs. 34.1 } 1.3C, 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. en-copyright= kn-copyright= en-aut-name=TakedaYoshimasa en-aut-sei=Takeda en-aut-mei=Yoshimasa kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=1 ORCID= en-aut-name=KawashimaTakahisa en-aut-sei=Kawashima en-aut-mei=Takahisa kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=2 ORCID= en-aut-name=KiyotaKazuya en-aut-sei=Kiyota en-aut-mei=Kazuya kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=3 ORCID= en-aut-name=OdaShigeto en-aut-sei=Oda en-aut-mei=Shigeto kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=4 ORCID= en-aut-name=MorimotoNaoki en-aut-sei=Morimoto en-aut-mei=Naoki kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=5 ORCID= en-aut-name=KobataHitoshi en-aut-sei=Kobata en-aut-mei=Hitoshi kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=6 ORCID= en-aut-name=IsobeHisashi en-aut-sei=Isobe en-aut-mei=Hisashi kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=7 ORCID= en-aut-name=HondaMitsuru en-aut-sei=Honda en-aut-mei=Mitsuru kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=8 ORCID= en-aut-name=FujimiSatoshi en-aut-sei=Fujimi en-aut-mei=Satoshi kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=9 ORCID= en-aut-name=OndaJun en-aut-sei=Onda en-aut-mei=Jun kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=10 ORCID= en-aut-name=ISeishi en-aut-sei=I en-aut-mei=Seishi kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=11 ORCID= en-aut-name=SakamotoTetsuya en-aut-sei=Sakamoto en-aut-mei=Tetsuya kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=12 ORCID= en-aut-name=IshikawaMasami en-aut-sei=Ishikawa en-aut-mei=Masami kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=13 ORCID= en-aut-name=NakanoHiroshi en-aut-sei=Nakano en-aut-mei=Hiroshi kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=14 ORCID= en-aut-name=SadamitsuDaikai en-aut-sei=Sadamitsu en-aut-mei=Daikai kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=15 ORCID= en-aut-name=KishikawaMasanobu en-aut-sei=Kishikawa en-aut-mei=Masanobu kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=16 ORCID= en-aut-name=KinoshitaKosaku en-aut-sei=Kinoshita en-aut-mei=Kosaku kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=17 ORCID= en-aut-name=YokoyamaTomoharu en-aut-sei=Yokoyama en-aut-mei=Tomoharu kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=18 ORCID= en-aut-name=HaradaMasahiro en-aut-sei=Harada en-aut-mei=Masahiro kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=19 ORCID= en-aut-name=KitauraMichio en-aut-sei=Kitaura en-aut-mei=Michio kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=20 ORCID= en-aut-name=IchiharaKiyoshi en-aut-sei=Ichihara en-aut-mei=Kiyoshi kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=21 ORCID= en-aut-name=HashimotoHiroshi en-aut-sei=Hashimoto en-aut-mei=Hiroshi kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=22 ORCID= en-aut-name=TsujiHidekazu en-aut-sei=Tsuji en-aut-mei=Hidekazu kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=23 ORCID= en-aut-name=YorifujiTakashi en-aut-sei=Yorifuji en-aut-mei=Takashi kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=24 ORCID= en-aut-name=NaganoOsamu en-aut-sei=Nagano en-aut-mei=Osamu kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=25 ORCID= en-aut-name=KatayamaHiroshi en-aut-sei=Katayama en-aut-mei=Hiroshi kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=26 ORCID= en-aut-name=UjikeYoshihito en-aut-sei=Ujike en-aut-mei=Yoshihito kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=27 ORCID= en-aut-name=MoritaKiyoshi en-aut-sei=Morita en-aut-mei=Kiyoshi kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=28 ORCID= affil-num=1 en-affil= kn-affil=Department of Anesthesiology, Okayama University Medical School affil-num=2 en-affil= kn-affil=Department of Emergency and Critical Care Medicine, Iseikai Hospital affil-num=3 en-affil= kn-affil=Tertiary Emergency Medical Center, Saitama Red-Cross Hospital affil-num=4 en-affil= kn-affil=Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine affil-num=5 en-affil= kn-affil=Emergency and Critical Care Center, Tsuyama Central Hospital affil-num=6 en-affil= kn-affil=Osaka Mishima Emergency Critical Care Center affil-num=7 en-affil= kn-affil=Department of Emergency Diagnosis and Treatment, Himeji Medical Center affil-num=8 en-affil= kn-affil=Emergency and Critical Care Center, Toho University Faculty of Medicine affil-num=9 en-affil= kn-affil=Critical Care and Trauma Center, Osaka General Medical Center affil-num=10 en-affil= kn-affil=Department of Neurosurgery, Kitakyushu Yugawa Hospital affil-num=11 en-affil= kn-affil=Department of Emergency Medicine, Japanese Red Cross Kumamoto Hospital affil-num=12 en-affil= kn-affil=Trauma and Resuscitation Center, Teikyo University School of Medicine affil-num=13 en-affil= kn-affil=Emergency Department, Kure Kyosai Hospital affil-num=14 en-affil= kn-affil=Emergency Department, Okazaki City Hospital affil-num=15 en-affil= kn-affil=Emergency and Critical Care Center, Osaka Medical Center affil-num=16 en-affil= kn-affil=Emergency and Critical Care Center, Saiseikai Fukuoka General Hospital affil-num=17 en-affil= kn-affil=Emergency and Critical Care Center, Nihon University Itabashi Hospital affil-num=18 en-affil= kn-affil=Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center affil-num=19 en-affil= kn-affil=Emergency and Critical Care Center, Kumamoto Medical Center affil-num=20 en-affil= kn-affil=Department of Emergency and Critical Care Medicine, Kagawa Rosai Hospital affil-num=21 en-affil= kn-affil=Department of Clinical Laboratory Science, Yamaguchi University Graduate School of Medicine affil-num=22 en-affil= kn-affil=Daiken Medical Co. affil-num=23 en-affil= kn-affil=Daiken Medical Co. affil-num=24 en-affil= kn-affil=Department of Human Ecology, Okayama University Graduate School of Environmental and Life Science affil-num=25 en-affil= kn-affil=Department of Disaster and Emergency Medicine, Kochi University Medical School affil-num=26 en-affil= kn-affil=Department of Anesthesiology and Intensive Care Medicine, Kawasaki Medical School affil-num=27 en-affil= kn-affil=Department of Emergency and Critical Care Medicine, Okayama University Medical School affil-num=28 en-affil= kn-affil=Department of Anesthesiology, Okayama University Medical School en-keyword=Brain ischaemia kn-keyword=Brain ischaemia en-keyword=Cardiac arrest kn-keyword=Cardiac arrest en-keyword=Intra-arrest cooling kn-keyword=Intra-arrest cooling en-keyword=Pharynx kn-keyword=Pharynx en-keyword=Selective cooling kn-keyword=Selective cooling en-keyword=Therapeutic hypothermia kn-keyword=Therapeutic hypothermia END