Cool! Chilling the brain with nasal cooling device during CPR may be a simple way to increase survival after cardiac arrest.

Recently, people hospitalized after cardiac arrest have been cooled to reduce injury to the brain and other tissues. Evidence suggests that this procedure, known as “therapeutic hypothermia,” reduces damage that occurs when the blood supply returns after being temporarily halted during cardiac arrest.

However, standard body cooling may not cool the brain soon enough or well enough to prevent neurological damage. (Saving your heart but not your brain is NOT a desirable outcome!) One problem has to do with the simple biophysics of cardiac arrest. Body cooling works if there is blood that travels to the brain leading to protective lower brain temperatures. Without blood circulation (as in cardiac arrest) or less than optimal blood flow (which may occur with prolonged CPR) it’s hard to quickly lower brain temperature. Also, waiting until a patient arrives at the hospital may delay neuroprotective cooling by an hour or more.

Now, in the PRINCE (Pre-Resuscitation Intra-Nasal Cooling Effectiveness) study, investigators at 15 centers across Europe used a new tool, RhinoChill, that cools the brain during ongoing cardiopulmonary resuscitation (CPR). (The name has nothing to do with the animal; “rhinos” is Greek for nose.) RhinoChill is a non-invasive device that introduces coolant through nasal prongs. The system is battery-powered, simple to operate, and requires no refrigeration, making it highly suitable for use by emergency medical technicians while delivering CPR and other necessary out-of-hospital emergency treatment.

In this randomized study, 46.7% of those cooled survived to hospital discharge, compared with 31% who receiving standard care. Those who received treatment fastest (under 10 minutes) had the best outcomes.

This technology will likely be available in Europe in early 2010, with studies continuing here in the United States.