Published Online
on July 25, 2005

A more recent version of this article appeared on August 2, 2005

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Submitted on February 21, 2005
Revised on April 9, 2005
Accepted on April 20, 2005

Pilot Study of Rapid Infusion of 2 L of 4°C Normal Saline for Induction of Mild Hypothermia in Hospitalized, Comatose Survivors of Out-of-Hospital Cardiac Arrest

Francis Kim MD^*, Michele Olsufka RN, David Carlbom MD, Steven Deem MD, W. T. Longstreth Jr MD, Margret Hanrahan RN, Charles Maynard PhD, Michael K. Copass MD, and Leonard A. Cobb MD

From the Departments of Medicine (F.K., M.O., D.C., S.D., M.H., M.K.C., L.A.C.), Neurology (W.T.L., M.K.C.), Anesthesiology (S.D.), and Health Services (C.M.), Harborview Medical Center, University of Washington, Seattle.

^* To whom correspondence should be addressed. E-mail: fkim{at}u.washington.edu.

Background--Recent clinical studies have demonstrated that mild hypothermia (32°C to 34°C) induced by surface cooling improves neurological outcome after resuscitation from out-of-hospital cardiac arrest. Results from animal models suggest that the effectiveness of mild hypothermia could be improved if initiated as soon as possible after return of spontaneous circulation. Infusion of cold, intravenous fluid has been proposed as a safe, effective, and inexpensive technique to induce mild hypothermia after cardiac arrest.

Methods and Results--In 17 hospitalized survivors of out-of-hospital cardiac arrest, we determined the effect on temperature and hemodynamics of infusing 2 L of 4°C cold, normal saline during 20 to 30 minutes into a peripheral vein with a high-pressure bag. Data on vital signs, electrolytes, arterial blood gases, and coagulation were collected before and after fluid infusion. Cardiac function was assessed by transthoracic echocardiography before fluid administration and 1 hour after infusion. Passive (fans, leaving patient uncovered) or active (cooling blankets, neuromuscular blockade) cooling measures were used to maintain mild hypothermia for 24 hours. Infusion of 2 L of 4°C cold, normal saline resulted in a mean temperature drop of 1.4°C 30 minutes after the initiation of infusion. Rapid infusion of fluid was not associated with clinically important changes in vital signs, electrolytes, arterial blood gases, or coagulation parameters. The initial mean ejection fraction was 34%, and fluid infusion did not affect ejection fraction or increase central venous pressure, pulmonary pressures, or left atrial filling pressures as assessed by echocardiography. Passive measures were ineffective in maintaining hypothermia compared with active measures.

Conclusions--Infusion of 2 L of 4°C cold, normal saline is safe and effective in rapidly lowering body temperature in survivors of out-of-hospital cardiac arrest.

Key words: cardiopulmonary resuscitation • hypothermia • heart arrest • echocardiography

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