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The “ICE” Study: Feasibility of Inexpensive Commercial Coolers on Mobile EMS Units

Published online by Cambridge University Press:  11 June 2014

Kathleen E. Kane*
Affiliation:
Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PennsylvaniaUSA
Robert J. Tomsho
Affiliation:
Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PennsylvaniaUSA
Karen Pheasant
Affiliation:
Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PennsylvaniaUSA
Thomas Stauffer
Affiliation:
Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PennsylvaniaUSA
Brent Schoenfeldt
Affiliation:
Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PennsylvaniaUSA
Scott Hamilton
Affiliation:
Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PennsylvaniaUSA
Travis Kain
Affiliation:
Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PennsylvaniaUSA
Bryan G. Kane
Affiliation:
Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PennsylvaniaUSA
*
Correspondence: Kathleen Kane, MD Lehigh Valley Health Network 1240 South Cedar Crest Boulevard, Suite #212 Allentown, PA 18103 USA E-mail Kathleen_E.Kane@lvh.com

Abstract

Introduction

Prehospital postresuscitation induced hypothermia (IH) has been shown to reduce neurological complications in comatose cardiac-arrest survivors. Retrofitting ambulances to include equipment appropriate to initiate hypothermia, such as refrigeration units for cooled saline, is expensive. The objective of this nonhuman subject research study was to determine if inexpensive, commercially available coolers could, in conjunction with five reusable ice packs, keep two 1 L bags of precooled 0.9% normal saline solution (NSS) at or below 4°C for an average shift of eight to 12 hours in a real-world environment, on board in-service Emergency Medical Service (EMS) units, over varying weather conditions in all seasons.

Methods

The coolers were chosen based on availability and affordability from two nationally available brands: The Igloo MaxxCold (Igloo Products Corp., Katy, Texas USA) and Coleman (The Coleman Company, Wichita, Kansas USA). Both are 8.5 liter (nine-quart) coolers that were chosen because they adequately held two 1 L bags of saline solution, along with the reusable ice packs designated in the study design, and were small enough for ease of placement on ambulances. Initial testing of the coolers was conducted in a controlled environment. Thereafter, each EMS unit was responsible to cool the saline to less than 4°C prior to shift. Data were collected by emergency medical technicians, paramedics, and resident physicians working in seven different ambulance squads. Data analysis was performed using repeated measurements recorded over a 12-hour period from 19 individual coolers and were summarized by individual time points using descriptive statistics.

Results

Initial testing determined that the coolers maintained temperatures of 4°C for 12 hours in a controlled environment. On the ambulances, results based on the repeated measurements over time revealed that the saline solution samples as defined in the protocol, remained consistently below 4°C for 12 hours. Utilizing the lower bound of the 2-sided 95% exact binomial confidence intervals, there was less than a five percent chance that saline samples could not be maintained below 4°C for 12 hours, even during the summer months.

Conclusions

Simple, commercially available coolers can maintain two 1 L bags of 0.9% NSS at 4°C for 12 hours in ambulances in varying environmental conditions. This suggests that EMS agencies could inexpensively initiate prehospital IH in appropriate cases.

KaneKE, TomshoRJ, PheasantK, StaufferT, SchoenfeldtB, HamiltonS, KainT, KaneBG. The “ICE” Study: Feasibility of Inexpensive Commercial Coolers on Mobile EMS Units. Prehosp Disaster Med. 2014;29(3):1-8.

Type
Original Research
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

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References

1. Rosamond, W, Flegal, K, Furie, K, et al. Heart disease and stroke statistics-2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117(4):e25-e146.Google Scholar
2. Nolan, J, Morley, P, Hoek, T, Hickey, R. Therapeutic hypothermia after cardiac arrest: an advisory statement by the Advancement Life Support Task Force of the International Liaison Committee on Resuscitation. Resuscitation. 2003;57(3):231-235.Google Scholar
3. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346(8):549-556; Erratum in: N Engl J Med. 2002;346(22):1756.Google Scholar
4. Bernard, S, Gray, T, Buist, M, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346(8):557-563.Google Scholar
5. Abella, B, Zhao, D, Alvarado, J, Hamann, K, Vanden Hoek, T, Becker, L. Intra-arrest cooling improves outcomes in murine cardiac arrest model. Circulation. 2004;109(22):2786-2791.Google Scholar
6. Bernard, S, Buist, M, Monteiro, O, Smith, K. Induced hypothermia using large volume, ice-cold intravenous fluids in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation. 2003;56(1):9-13.Google Scholar
7. Idris, A, Roberts, L 2nd, Caruso, L, et al. Oxidant injury occurs rapidly after cardiac arrest, cardiopulmonary resuscitation, and reperfusion. Crit Care Med. 2005;33(9):2043-2048.Google Scholar
8. Suffoletto, B, Salcido, D, Menegazzi, J. Use of prehospital-induced hypothermia after out-of-hospital cardiac arrest: a survey of the National Association of Emergency Medical Services Physicians. Prehosp Emerg Care. 2008;12(1):52-56.Google Scholar
9. Freese, J. Driving toward “cool” resuscitation care: following a successful hospital-based hypothermia program, New York begins inducing cooling in the field. JEMS. 2010;35(9):suppl9-10.Google Scholar
10. The Bureau of EMS, PA Department of Health. Statewide Advanced Life Support Protocols. Distributed May 4, 2011; effective July 1, 2011. http://www.portal.state.pa.us/portal/server.pt?parentname=SearchResult&space=SearchResult&in_tx_query=Advanced+Life+Support+Protocols+& parentid=5&in_hi_userid=2& control=bannerstart&cached=false Google Scholar
11. Bernard, SA, Smith, K, Cameron, P, et al. Rapid Infusion of Cold Hartmanns (RICH) Investigators. Induction of therapeutic hypothermia by paramedics after resuscitation from out-of-hospital ventricular fibrillation cardiac arrest: a randomized controlled trial. Circulation. 2010;122(7):737-742.Google Scholar
12. Kim, F, Nichol, G, Maynard, C, et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA. 2014;311(1):45-52.Google Scholar