6 Animal data consistently show that a delay in cooling negates the beneficial effect of mild hypothermia,8,

9, 10, 11 and 12 whereas human studies show inconsistent results concerning the beneficial effect of early cooling.13, 14, 15, 16, 17, 18 and 19 These results might be partly explained by the retrospective design of the studies and various cooling methods used13, 14, 15, 16 and 17 or by the shortcomings of the cooling procedure itself.18, 19 and 20 A recently published randomized study showed no effects on outcome in early cooling versus late cooling with intravenous (i.v.) cold normal saline. Surprisingly, more rearrests and pulmonary edema in patients Selleckchem CAL101 cooled in the prehospital setting were observed.21 In that study, volume overload may have led to the complications that were reported. An alternative cooling method that ensures rapid cooling and reliable maintenance of mild hypothermia but minimizes risk of pulmonary edema and/or re-arrest would be preferred. Recently, several different invasive and non-invasive cooling methods have been developed,22, 23, 24, 25, 26, 27 and 28 but some of them are not feasible for the use by emergency medical service in the pre-hospital setting. However, one non-invasive, external cooling pad (EMCOOLS Flex.Pad®) with fast cooling rate was evaluated and successfully

implemented in out-of-hospital GSK2118436 mouse and in-hospital post-resuscitation care.29 and 30 The primary objective of Tyrosine-protein kinase BLK this study in patients successfully resuscitated from out-of-hospital cardiac arrest was to compare the time to target temperature between patients non-invasively cooled in the prehospital setting and patients cooled after admission using a conventional non-invasive in-hospital (IH) approach. We also assessed safety profile and long-term neurological outcome. This was a retrospective observational study carried out in cooperation with the Municipal Ambulance Service of Vienna. Data of a convenience sample of consecutive patients treated by the Ambulance Service after out-of-hospital cardiac arrest and transported to the department of emergency medicine of a tertiary care university hospital were collected and analyzed. The institutional ethical review board has approved

this registry and the procedures were in accordance with the ethical standards. The ethical review board did not review individual patient records. The primary endpoint of this study was time (from ROSC) to target temperature (33.9 °C, as recommended by international guidelines5 and 6) of patients after cardiac arrest with prehospital treatment compared to patients with IH treatment. The secondary endpoints were hospital admission temperature, time to admission after restoration of spontaneous circulation (ROSC) and neurological outcome after 12 months. Furthermore, the number of rearrests and pulmonary edema was recorded in both groups. The inclusion and exclusion criteria for prehospital cooling were identical to those in our prior feasibility study.