Design of the RINSE Trial: The Rapid Infusion of cold Normal Saline by paramedics during CPR

Ambulance Victoria, Victoria, Australia.
BMC Emergency Medicine 10/2011; 11(1):17. DOI: 10.1186/1471-227X-11-17
Source: PubMed


The International Liaison Committee on Resuscitation (ILCOR) now recommends therapeutic hypothermia (TH) (33 °C for 12-24 hours) as soon as possible for patients who remain comatose after resuscitation from shockable rhythm in out-of-hospital cardiac arrest and that it be considered for non shockable rhythms. The optimal timing of TH is still uncertain. Laboratory data have suggested that there is significantly decreased neurological injury if cooling is initiated during CPR. In addition, peri-arrest cooling may increase the rate of successful defibrillation. This study aims to determine whether paramedic cooling during CPR improves outcome compared standard treatment in patients who are being resuscitated from out-of-hospital cardiac arrest.
This paper describes the methodology for a definitive multi-centre, randomised, controlled trial of paramedic cooling during CPR compared with standard treatment. Paramedic cooling during CPR will be achieved using a rapid infusion of large volume (20-40 mL/kg to a maximum of 2 litres) ice-cold (4 °C) normal saline.The primary outcome measure is survival at hospital discharge. Secondary outcome measures are rates of return of spontaneous circulation, rate of survival to hospital admission, temperature on arrival at hospital, and 12 month quality of life of survivors.
This trial will test the effect of the administration of ice cold saline during CPR on survival outcomes. If this simple treatment is found to improve outcomes, it will have generalisability to prehospital services globally. NCT01172678.

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Article: Design of the RINSE Trial: The Rapid Infusion of cold Normal Saline by paramedics during CPR

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    • "Animal data suggest that intraarrest cooling is clearly superior to postresuscitation cooling (Abella et al., 2004). There are a few clinical trials underway to test the effect of inducing hypothermia during CPR using icecold intravenous saline (Deasy et al., 2011b) or nasopharyngeal cooling (Castren et al., 2010; Nordberg et al., 2013). "
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    ABSTRACT: Therapeutic hypothermia (TH), where patients are cooled to between 32°C and 36°C for a period of 12-24 hours and then gradually rewarmed, may reduce the risk of ischemic injury to cerebral tissue following a period of insufficient blood flow. This strategy of TH could improve mortality and neurological function in patients who have experienced out-of-hospital cardiac arrest (OOHCA). The necessity of TH in OOHCA was challenged in late 2013 by a fascinating and potentially practice changing publication, which found that targeting a temperature of 36°C had similar outcomes to cooling patients to 33°C. This article reviews the current literature and summarizes the uncertainties and questions raised when considering cooling of patients at risk of hypoxic brain injury. Irrespective of whether TH or targeted temperature management is deployed in patients at risk of hypoxic brain injury, it would seem that avoiding hyperpyrexia is important and that a more rigorous approach to neurological evaluation is mandated.
    11/2014; 5(1). DOI:10.1089/ther.2014.0019
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    ABSTRACT: Many consider attempted resuscitation for traumatic out-of-hospital cardiac arrest (OHCA) futile. This study aims to describe the characteristics and profile of paediatric traumatic OHCA. The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify all trauma related cases of OHCA in patients aged less than 16 years of age. Cases were linked with their coronial findings. Between 2000 and 2009, EMS attended 33,722 OHCAs including 2187 adult traumatic OHCAs. There were 538 (1.6%) OHCAs in children less than 16 years of age of which n=64 were due to trauma. The median age (IQR) of paediatric traumatic OHCA was 7 (4.5-13) years and 44 were male (69%). Bystander CPR was performed in 22 cases (34.4%). The first recorded rhythm by EMS was asystole seen in 42 (66%), PEA in 14 (22%) cases and VF in 2 cases (3%). Cardiac output was present in 7 (11%) cases who subsequently had an EMS witnessed OHCA. EMS attempted resuscitation in 35 (55%) patients of whom 7 (20%) achieved ROSC and were transported, and 1 (3%) survived to hospital discharge with severe neurological sequelae; 14(40%) were transported with CPR of whom none survived. Coronial cause of death was multiple injuries in 35%, head injury in 33%, head and neck injury in 10%, chest injuries in 10% and other causes (12%). Traumatic aetiology of OHCA when compared to the incidence of adult traumatic OHCAs is uncommon. Resuscitation efforts are seldom effective and associated with poor neurological outcome.
    Resuscitation 11/2011; 83(4):471-5. DOI:10.1016/j.resuscitation.2011.11.009 · 4.17 Impact Factor
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    ABSTRACT: The literature survey 2011 is based on 1730 papers found in the databases MEDLINE and EMBASE with the keywords “thermography” or “thermometry” or “thermotherapy” or ‘skin temperature’ or ‘core temperature’ and restricted to “included in the databases between 01.01 and 31.12. 2011”. 36,5 percent of papers of this review are originated from Europe and 96 percent of all papers are written in English. 588 controlled studies using some kind of temperature measurement were included in this survey. Physiology, cardiovascular diseases, neurology, dermatology and clinical & experimental pharmacology were the predominant fields of applications of temperature measurement in medicine. As in previous years, therapeutic hypothermia and hyperthermia treatment was the topic of many papers. Fever attracted also a high number of publications. Some articles were related to sleep or pain. Only few papers were found for intravascular temperature measurement, Raynaud´s phenomenon or breast thermography.
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