Feasibility of intra-arrest hypothermia induction: A novel nasopharyngeal approach achieves preferential brain cooling

Aim

In patients with cardiopulmonary arrest, brain cooling may improve neurological outcome, especially if applied prior to or during early reperfusion. Thus it is important to develop feasible cooling methods for pre-hospital use. This study examines cerebral and compartmental thermokinetic properties of nasopharyngeal cooling during various blood flow states.

Methods

Ten swine (40 ± 4 kg) were anesthetized, intubated and monitored. Temperature was determined in the frontal lobe of the brain, in the aorta, and in the rectum. After the preparatory phase the cooling device (RhinoChill™ system), which produces evaporative cooling in the nasopharyngeal area, was activated for 60 min. The thermokinetic response was evaluated during stable anaesthesia (NF, n = 3); during untreated cardiopulmonary arrest (ZF, n = 3); during CPR (LF, n = 4).

Results

Effective brain cooling was achieved in all groups with a median cerebral temperature decrease of −4.7 °C for NF, −4.3 °C for ZF and −3.4 °C for LF after 60 min. The initial brain cooling rate however was fastest in NF, followed by LF, and was slowest in ZF; the median brain temperature decrease from baseline after 15 min of cooling was −2.48 °C for NF, −0.12 °C for ZF, and −0.93 °C for LF, respectively. A median aortic temperature change of −2.76 °C for NF, −0.97 for LF and +1.1 °C for ZF after 60 min indicated preferential brain cooling in all groups.

Conclusion

While nasopharyngeal cooling in swine is effective at producing preferential cerebral hypothermia in various blood flow states, initial brain cooling is most efficient with normal circulation.