Efficacy and safety of early rapid infusion of icy normal saline in patients after cardiopulmonary resuscitation / 中华危重病急救医学

ABSTRACT

Objective To assess the feasibility,safety,and effectiveness of early rapid icy normal saline infusion to attain mild hypothermia in cardiac arrest patients. Methods A single-center prospective randomized controlled trial was conducted. From March 2011 to October 2013,patients who had recovery of spontaneous circulation (ROSC)after cardiopulmonary resuscitation (CPR)in Beijing Daxing District People's Hospital were randomly divided into two groups. In icy normal saline group,patients received a rapid infusion of 1 000 mL of 4 ℃ normal saline intravenously to attain a mild hypothermia. In the control group,the patients were treated with ice bag on head,and axillary temperature was monitored. For all patients,rectal temperature was measured and recorded immediately and 1 hour later . The occurrence of pulmonary edema on initial chest X-ray at 6 hours ,occurrence of tremor within 48 hours,ventricular fibrillation recurring within 48 hours,and consciousness or death within 14 days were recorded. Results A total of 45 patients were enrolled,including 23 patients in icy normal saline group and 22 in control group. The patients in icy normal saline group had a rectal temperature descended from(36.7±0.9)℃to(34.9±0.7)℃1 hour later,while the patients in control group had a rectal temperature risen from(36.5±1.0)℃to(37.9±0.9)℃1 hour later. There was significant difference in rectal temperature between two groups (t=2.228,P=0.031). The number of patients who successfully awaken within 14 days in ice normal saline group was significantly larger than that in control group (13 cases vs. 7 cases,χ2=65.710,P=0.021). There was no statistical difference in the occurrence of acute pulmonary edema (4 cases vs . 6 cases),tremor (2 cases vs . 0 case),ventricular fibrillation recurrence (4 cases vs. 5 cases)and death within 14 days (11 cases vs. 12 cases,all P>0.05). Conclusions The study shows that early rapid i.v. infusion of 4℃normal saline is feasible,safe and effective for cerebral resuscitation.