Intra-arrest rapid head cooling improves postresuscitation myocardial function in comparison with delayed postresuscitation surface cooling

Objective: To compare resuscitation outcomes and myocardial function among intra-arrest head cooling, delayed surface cooling, and uncooled controls. Design: Prospective animal study. Setting: University-affiliated animal research laboratory. Subjects: Twenty-four male domestic pigs. Interventions: Ventricular fibrillation remained untreated for 10 mins after which animals were assigned into three groups: 1) intra-arrest head cooling, 2) postresuscitation surface cooling, and 3) uncooled controls. Head cooling by evaporative perfluorochemical began coincident with the start of cardiopulmonary resuscitation and continued for a total of 4 hrs. Surface cooling using a cooling blanket began at 2 hrs after return of spontaneous circulation and continued for 8 hrs. Control animals were treated identically with the exception for cooling. Measurements and Main Results: Return of spontaneous circulation was achieved in eight of eight head-cooled animals, in seven of eight surface-cooled animals, and in seven of eight of controls. Myocardial functions measured by transthoracic echocardiography were significantly better in the head-cooled animals than in surface-cooled and controls. All head-cooled animals survived for more than 96 hrs. This contrasted with six of eight survivors after surface cooling, and only two of eight among controls. Conclusions: Both intra-arrest head cooling and delayed surface cooling improved postresuscitation myocardial dysfunction. The beneficial effects were greatest with head cooling initiated with cardiopulmonary resuscitation. (Crit Care Med 2008; 36[Suppl.]:S434-S439)