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)

Stephen A. Bernard, Karen Smith, Judith Finn, Cindy Hein, Hugh Grantham, Janet E. Bray, Conor Deasy, Michael Stephenson, Teresa A. Williams, Lahn D. Straney, Deon Brink, Richard Larsen, Chris Cotton, Peter Cameron

Research output: Contribution to journalArticleResearchpeer-review

27 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)797-805
Number of pages9
JournalCirculation
Volume134
Issue number11
DOIs
Publication statusPublished - 13 Sep 2016

Keywords

  • cardiac arrest
  • cardiopulmonary resuscitation
  • clinical trial
  • emergency medical services
  • therapeutic hypothermia

Cite this

@article{0144de59a1b548c0bc0c9eb46e802f56,
title = "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)",
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.",
keywords = "cardiac arrest, cardiopulmonary resuscitation, clinical trial, emergency medical services, therapeutic hypothermia",
author = "Bernard, {Stephen A.} and Karen Smith and Judith Finn and Cindy Hein and Hugh Grantham and Bray, {Janet E.} and Conor Deasy and Michael Stephenson and Williams, {Teresa A.} and Straney, {Lahn D.} and Deon Brink and Richard Larsen and Chris Cotton and Peter Cameron",
year = "2016",
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doi = "10.1161/CIRCULATIONAHA.116.021989",
language = "English",
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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, Stephen A.; Smith, Karen; Finn, Judith; Hein, Cindy; Grantham, Hugh; Bray, Janet E.; Deasy, Conor; Stephenson, Michael; Williams, Teresa A.; Straney, Lahn D.; Brink, Deon; Larsen, Richard; Cotton, Chris; Cameron, Peter.

In: Circulation, Vol. 134, No. 11, 13.09.2016, p. 797-805.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Induction of therapeutic hypothermia during out-of-hospital cardiac arrest using a rapid infusion of cold saline

T2 - The RINSE Trial (Rapid Infusion of Cold Normal Saline)

AU - Bernard, Stephen A.

AU - Smith, Karen

AU - Finn, Judith

AU - Hein, Cindy

AU - Grantham, Hugh

AU - Bray, Janet E.

AU - Deasy, Conor

AU - Stephenson, Michael

AU - Williams, Teresa A.

AU - Straney, Lahn D.

AU - Brink, Deon

AU - Larsen, Richard

AU - Cotton, Chris

AU - Cameron, Peter

PY - 2016/9/13

Y1 - 2016/9/13

N2 - 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.

AB - 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.

KW - cardiac arrest

KW - cardiopulmonary resuscitation

KW - clinical trial

KW - emergency medical services

KW - therapeutic hypothermia

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U2 - 10.1161/CIRCULATIONAHA.116.021989

DO - 10.1161/CIRCULATIONAHA.116.021989

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SN - 0009-7322

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