DocGlobal

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Again, welcome! Doc James (talk · contribs · email) 22:47, 2 January 2015 (UTC)

Randomised pilot studies

Such as this one "a randomised pilot study comparing cold infusions with nasopharyngeal cooling" are not very good sources. We should try to use secondary sources such as review articles and position statements per WP:MEDRS. Best Doc James (talk · contribs · email) 09:42, 3 January 2015 (UTC)

Please, consider that Critical Care is one of the top journals in this segment. The randomised study is a good source and a new one (2014 Oct 27). The topic is important because to rewarm too fast is associated with poor outcome. Reperfusion injury is key to poor outcome. That is why the guidelines tell us about 0.25°C/h in the end, but not in the middle or much more. However, cold saline as a stand allone solution like in the Kim-study provides a bad rebound in temperature - down and up. Think off 1-2 liter cold saline vs. 60-100 kg body mass, what happens within an hour? The iCool1 and iCool3 studies gives the answer, plus an important solution: A combination of cold saline infusion plus surface cooling provides a steady cooling curve without rewarming. Please, do not kick this evidence out of wikipedia. Thanks for your wellcome and a lot.--DocGlobal (talk) 20:11, 3 January 2015 (UTC)

Discussion

Can we discuss this: "Intra-CPR therapeutic hypothermia significantly reduces myocardial infarction size. Database of International Cardiac Arrest Registry found poor neurological outcome increased by 8% with each 5 min delay in initiating therapeutic hypothermia and by 17% for every 30 min delay in time to target temperature. Therapeutic hypothermia is the only strategy able to provide effective and early neuroprotection in clinical practice."

1. "Intra-CPR therapeutic hypothermia significantly reduces myocardial infarction size" [1] is primary source using an animal model. Beginning cooling during CPR is not commented by ILCOR at this point in time.
2. "Database of International..." does not pertain to treatment during CPR
3. The third ref is good. It states "Despite some positive effects on cardiac function, animal studies yielded conflicting results regarding mortality, because only in a minority of cases higher survival rates were showed in animals treated with IATH. Nevertheless, almost all animal findings agree to confirm a better neurological performance in the IATH group compared with both normothermia and post-ROSC hypothermia. Indeed, animal models are quite far from real life..." Doc James (talk · contribs · email) 10:30, 3 January 2015 (UTC)

This is followed by "In the only human RCT in the field of IATH[25], Castren et al. [23] randomized patients to receive either standard treatment with inhospital therapeutic hypothermia or to the use of a TNEC device during CPR. Among the 200 enrolled patients, 104 received standard therapy and 96 IATH, with the last ones having a significantly lower temperature at hospital admission (34.2 ± 1.5°C versus 35.5 ± 0.9°C, P < 0.001) and a lower time to target temperature (284 versus 155 min, respectively, P < 0.01). However, IATH did not result in any improvement in survival rate or good neurological outcome; only in the subgroup of patients with a time from collapse to CPR below 10 min, IATH was associated with higher rate of survivors and of good neurological recovery (56.5 versus 29.4%, P = 0.04; 43.5 versus 17.6%, P = 0.03, respectively)."

I think the most we should say is that "cooling during CPR is being studied as of 2014". Doc James (talk · contribs · email) 10:45, 3 January 2015 (UTC)

Repeating content

• We state in the first sentence "A November 2013 trial found that actively cooling to a temperature of 36 °C (97 °F)"
• There is no reason to mention it again two sentences latter "However, in the trail active cooling was needed to reach and to maintain a 36.0°C temperature target strictly."? Doc James (talk · contribs · email) 11:41, 4 January 2015 (UTC)

Thoughts? Doc James (talk · contribs · email) 11:42, 4 January 2015 (UTC)

Refs

This is not a particularly good source.[2]

• 20 patients
• a pilot study
• 3 SAE in one arm 4 SAE in the other.
• about stroke not cardiac arrest thus why in the cardiac arrest section?

Thus does not really support "Infusion of cold saline drops the body temperature, but is rewarmed within less than one hour and may cause reperfusion injury, combination of cold saline infusion plus surface cooling provides a steady cooling curve without rewarming".

Additionally no one is using just 2l cold saline follow by no other cooling techniques. And we should try to use review articles and position statements. There are a lot on this topic. Rather than primary sources such as single studies. Doc James (talk · contribs · email) 13:53, 4 January 2015 (UTC)