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EDUCATION BULLETIN
May 31, 2007 Bulletin number: E00015
Invasive cooling vs. Non-invasive: Results from the HACA-R (Registry)
The HACA-R for Cardiac Arrest was created and supported by Alsius Corporation. The following findings represent 650 patients registered between March 2003 and June 2005. (In the first 7 months of data acquisition, only patients who were cooled with an endovascular cooling catheter could be entered in the registry. This was changed by the beginning of 2004, and the registry was opened for all patients with cardiac arrest). In 2006 this registry was integrated into the NHN registry (www.hypothermianetwork.com ) to form one unified European registry for all.
Complete list of Hospital Investigators and centers is available on page 1046-1047. (None of these centers were using the MTRE's technology).
How fast should we cool?
Although, the answer has not been determined in clinical studies, many care givers believe that target temperature should be reached as soon as possible.
It is reasonable to expect that invasive methods have a predominant advantage over noninvasive solutions in this regard, simply due to their internal and direct cooling.
Nevertheless,results from the HACA-R (Crit. Care Med 2007; Vol. 35, No. 4) show no such advantage, even when it comes to evaluate this key question.
Results analysis:
- 462 (79%) received therapeutic hypothermia.
- 347 (75%) invasively (ICY or Cool Line, Alsius Corporation) together with an external heat exchange system. (Most likely to prevent shivering).
- 114 (25%) were treated with another cooling method such as ice packs, cooling blankets, and cold fluids.
- In this registry: 13 of the 19 sites registered used endovascular cooling therapy.
- The median time from collapse to initiation of cooling was 159 min (IQR, 96– 244 min)
- The median time from ROSC to the initiation of cooling was 131 min (IQR, 75–218 min)
- 150 min (IQR, 94– 112 min) to initiate endovascular cooling
- 75 min (IQR, 26–130 min) to initiate surface cooling or to administer cold fluids.
- The coldest temperature reached with endovascular cooling (32.9°C; IQR, 32.6–33°C).
- The coldest temperature reached with all other cooling methods 32.4°C (IQR 31–32.9°C)
- Cooling Rate in the first hour of treatment was 1.1° C vs. 1.3° C (invasive vs. none-Invasive respectfully).
1. Advantage to invasive cooling over other methods used.
2. Invasive solution, expected to be very accurate, may also overshoot (up to 0.4° C).
Conclusion:
1. This study results show no real advantage to endovascular cooling.
2. On the contrary, it seems to be inferior in regards to cooling rate, which is highlighted as its prime advantage.
3. Possible complications "there was a trend toward a higher amount of arrhythmias for the endovascular group".
4. Any other cooling solutions mentioned here, provide good cooling capacity, yet its main disadvantage, are the lack of good temperature control – overshoot!!!
5. MTRE direct competition is all non-invasive solutions, especially such that can offer a better temperature feedback control.
6. MTRE can take pride in its non invasive solution and its good temperature control.
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