The RINSE Trial: Rapid Infusion of Cold Saline During CPR for Patients With Cardiac Arrest

INTRODUCTION:

Pre-hospital cardiac arrest is common and associated with a poor prognosis and only about 8% of patients have a good outcome. For patients who are initially successfully resuscitated by ambulance paramedics and transported to hospital, there is considerable mortality and morbidity. This is largely due to the anoxic brain injury sustained during the cardiac arrest.

One current therapy for the severe anoxic brain injury following out-of-hospital cardiac arrest is therapeutic hypothermia (TH) induced after resuscitation. This treatment was shown to improve outcomes in two clinical trials. The International Liaison Committee on Resuscitation now recommend TH (33°C for 12-24 hours) for patients who remain comatose after resuscitation from cardiac arrest.

However, the optimal timing of TH is still uncertain. The above clinical studies used surface cooling and this delayed TH until after arrival at the hospital. On the other hand, laboratory data has suggested that there is significantly decreased neurological injury if cooling is initiated during CPR.

The current ideal technique for induction of TH during CPR is a rapid intravenous infusion of a large volume of ice-cold fluid. This technique has become established as the cooling method of choice in the pre-hospital setting, the Emergency Department (14) and the Intensive Care Unit.