RINSE but don’t repeat

October 28, 2016

Short Attention Span Summary

Compressions, RINSE, but don’t repeat…
Does administration of 2L cold NS during prehospital CPR affect neurological outcome?  This RCT says no.  Survival to discharge was unchanged.  And there was a significant decrease in ROSC for those with an initial shockable rhythm who received cold saline.

Spoon Feed
Sadly, prehospital cold saline during CPR did not improve outcome and may have caused harm.

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Abstract

Circulation. 2016 Sep 13;134(11):797-805. doi: 10.1161/CIRCULATIONAHA.116.021989. Epub 2016 Aug 25.

Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline: The RINSE Trial (Rapid Infusion of Cold Normal Saline).

Bernard SA1, Smith K2, Finn J2, Hein C2, Grantham H2, Bray JE2, Deasy C2, Stephenson M2, Williams TA2, Straney LD2, Brink D2, Larsen R2, Cotton C2, Cameron P2.

Author information: 

• 1From Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.). steve.bernard@ambulance.vic.gov.au.
• 2From Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).

ABSTRACT

BACKGROUND: 

Patients successfully resuscitated by paramedics from out-of-hospital cardiac arrest often have severe neurologic injury. Laboratory and observational clinical reports have suggested that induction of therapeutic hypothermia during cardiopulmonary resuscitation (CPR) may improve neurologic outcomes. One technique for induction of mild therapeutic hypothermia during CPR is a rapid infusion of large-volume cold crystalloid fluid.

METHODS: 

In this multicenter, randomized, controlled trial we assigned adults with out-of-hospital cardiac arrest undergoing CPR to either a rapid intravenous infusion of up to 2 L of cold saline or standard care. The primary outcome measure was survival at hospital discharge; secondary end points included return of a spontaneous circulation. The trial was closed early (at 48% recruitment target) due to changes in temperature management at major receiving hospitals.

RESULTS: 

A total of 1198 patients were assigned to either therapeutic hypothermia during CPR (618 patients) or standard prehospital care (580 patients). Patients allocated to therapeutic hypothermia received a mean (SD) of 1193 (647) mL cold saline. For patients with an initial shockable cardiac rhythm, there was a decrease in the rate of return of a spontaneous circulation in patients who received cold saline compared with standard care (41.2% compared with 50.6%, P=0.03). Overall 10.2% of patients allocated to therapeutic hypothermia during CPR were alive at hospital discharge compared with 11.4% who received standard care (P=0.71).

CONCLUSIONS: 

In adults with out-of-hospital cardiac arrest, induction of mild therapeutic hypothermia using a rapid infusion of large-volume, intravenous cold saline during CPR may decrease the rate of return of a spontaneous circulation in patients with an initial shockable rhythm and produced no trend toward improved outcomes at hospital discharge.

CLINICAL TRIAL REGISTRATION: 

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01173393.

© 2016 American Heart Association, Inc.

PMID: 27562972 [PubMed – in process]