O

H HYPOTHERMIA Giuup □ NORMOTHERMIA Group

Figure 1 Complications at 0 to 7 days after cardiac arrest (European Hypothermia Study 2002). Devices and Methods of Induced Hypothermia

As hypothermia evolves as a therapy, the types of devices used to induce it are also increasing dramatically. Generally, these methods can be classified either as surface cooling or invasive (endovascular) cooling. The two controlled studies successfully used surface cooling, with the European group using external cooling by a mattress that delivers cold air over the entire body, and the Australian study using extensive application of ice packs around the head, neck, torso, and limbs (8,9). Some devices introduced for temperature control by means of invasive (endovascular) cooling (58,59) or surface cooling (60,61) have also been used to induce hypothermia. At the time of this writing, no published study comparing any of these hypothermia methods and devices is available. Although manufacturers of these devices claim the ability to induce hypothermia, it is important several factors be considered when deciding on which methods and devices to use, including: the clinical setting where cooling is initiated [in the field, in the emergency department, or in the intensive care unit (ICU)], the ability of the first responders to initiate hypothermia, the rapidity of induction and stability of temperature while in the therapeutic range (with careful consideration to maintain temperature in the desired range), the transportability of the device and the ability to allow procedures, such as cardiac catheter-ization, to be undertaken, the adverse effects associated with the specific method or device, and, lastly, the user-friendly interface of the device and how it facilitates or hampers provision of care in a critical care environment.

Another means of inducing hypothermia is to infuse ice-cold IV fluid after successful resuscitation in the field (62,63). Bernard et al. showed that rapid infusion of large volume (30 mL/kg), ice-cold (4°C) IV fluid would be a safe, rapid, and inexpensive technique to induce mild hypothermia in 22 comatose survivors of out-of-hospital CA (63). The ability of this method to rapidly initiate hypothermia, especially in the field, complements the established methods of surface and endovascular cooling in the Emergency Department or in the Critical Care Unit.

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