Intravenous Cold Saline

Iced normal saline infusions have been shown to be effective at rapidly reducing core temperatures (65-69). Healthy volunteers were cooled by 2.5°C within an hour of starting a 30-min infusion of 4°C saline (40 mL/kg) after neuromuscular block with vecuronium and general anesthesia (67). Twenty-two patients who were resuscitated from cardiac arrest were cooled by 1.7°C, with 30 mL/kg of 4°C lactated Ringers solution given over 30 min (65). All of these patients received neuromuscular blocking agents. In a similar study, 2 L of 4°C saline was given over 20 to 30 min following return of spontaneous circulation after cardiac arrest (68), resulting in a mean drop of 1.4°C 30 min after initiation of infusion. This drop in temperature did not affect the left ventricular ejection fraction, vital signs, or coagulation parameters.

Recently, a group that studied the feasibility of inducing hypothermia in a prehospital setting, using an infusion of 30 mL/kg of "ice-cold" Ringer's solution given at a rate of 100 mL/min to comatose patients with out-of-hospital cardiac arrest, was able to reduce core temperature from 35.8°C at onset of infusion to 34°C on arrival to hospital (69). Together, these studies demonstrate that the use if intravenous cold saline is a safe, easy-to-use and effective method of inducing systemic hypothermia.

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