7%) patients cooling was initiated at 11 (7–18) min after ROSC. In 29 (51.8%) patients, Tes at onset of prehospital cooling was 36.2 (35.7–36.6) °C. In 27 patients (48.2%), Tes was not measured in the prehospital setting. For other temperature and time data, see Table 2. In 54 patients, cooling was started at median of 88 (65–133) min after ROSC and 55 (35–110) min after admission. Target temperature was reached in 85 (66–117) min after ROSC in prehospital cooled patients and in 135 (102–192) min in IH cooled patients (p < 0.001). No difference in the rate of rearrests and pulmonary edema between groups has been observed ( Table 1). In both Akt assay groups, no

skin lesions were observed. On admission, prehospital and IH arterial blood gas parameters from the first sample did not differ except potassium, which was lower in prehospital cooled patients ( Table 3). The airway of all prehospital- and IH-cooled patients was secured with a tracheal tube. There was no significant difference in neurological outcome between groups. selleck compound In the prehospital cooling group, favorable outcome (CPC 1–2) was reached in 15 patients (26.8%) at 12 months, 37 (66.1%) died 8 (3–17) days after hospital admission. One patient with CPC 1 classified at 1 month after arrest was lost to further follow

up. In the IH group, 20 (37.0%) showed a CPC of 1–2 (p = 0.17) after 12 months, 33 patients (61.1%) died at a median of 5 (2–13) days (p = 0.33). This study of non-invasive prehospital vs. IH cooling in patients after cardiac arrest showed that target temperature (Tes) was reached significantly faster with prehospital

cooling, but surprisingly this difference was only minimally reflected in admission temperature. The shorter interval to target temperature in the prehospital cooling, however, did not translate in sustained neurologic benefits. Importantly, the pre-hospital surface cooling was not associated with higher rate of adverse events, namely re-arrests, than in-hospital cooling. To the best of our knowledge, this is the first study comparing temperature management using non-invasive surface IKBKE cooling in the prehospital vs. IH setting. Recently, controversy has arisen regarding the optimal time to begin cooling after cardiac arrest. In a recently published study, Kim et al.,21 reported no difference in neurologic outcome between patients cooled prehospital or IH. The cooling method used in the prehospital setting was an i.v. infusion of up to 2 L of cold saline initiated immediately after ROSC. A possible side effect of this approach was an observed higher number of cases of both pulmonary edema and re-arrest in the prehospital cooling group. From animal studies it is known that intra-arrest cooling with fluids decreases coronary perfusion pressure.33 Therefore, a hypothetical reason for a higher amount of rearrests and pulmonary edema in that study might have been the use of immediate cold i.v. infusion after ROSC.