Prehospital Cooling After Cardiac Arrest Is Not Necessary

Therapeutic hypothermia is guideline-recommended for comatose patients after cardiac arrest, but previous small studies of cooling prior to hospital arrival did not demonstrate benefit (NEJM JW Emerg Med Mar 9 2012, NEJM JW Emerg Med Sep 24 2010). Researchers in Washington State randomized cardiac arrest patients to standard care with or without paramedic-initiated cooling with intravenous 4°C normal saline, to determine the effect of prehospital cooling on survival and neurological status at hospital discharge.

Of 1359 patients, 583 had ventricular fibrillation and 776 did not. Mortality was similar in the prehospital-cooled and control groups; in patients with ventricular fibrillation (VF), 63% and 64% survived to discharge, while in patie…