Paramedics in Broward County, Florida are being trained in a new procedure that uses cold saline solution during post-resuscitation support of patients in cardiac arrest. The Broward paramedics are the latest to join some ten other cities and counties so far that have decided to adopt the novel life-saving approach.
The procedure involves pumping chilled salt water into the patient’s blood stream to slow metabolism and minimize damage to the brain and other vital organs that can often occur from hyperthermia and the lack of proper blood flow.
“The idea is to get the patient to a lower body temperature as quickly as possible, even before transport to the hospital begins,” said Broward County’s Chief of Emergency Medicine Nabil El Sanadi, MD.
The use of external cooling techniques such as ice bags has long been accepted practice but has often been criticized as too slow and ineffective in lowering the body’s temperature. Recent studies suggest that internal cooling through the use of cold saline or endovascular cooling catheters is far more effective.
A set of American Heart Association guidelines published in the journal Circulation in 2005 suggested that the use of induced permissive hypothermia above 32 degrees Centigrade (89.6 degrees Fahrenheit) can effectively result in positive outcomes in adults who remained comatose after initial resuscitation in an out-of-hospital ventricular fibrillation cardiac arrest.
The guidelines recommended that patients be cooled within a range of 32 to 34 degrees C for 12 to 24 hours. In two randomized clinical trials cited by the AHA, use of the cold saline process resulted in improved survival and brain function in adults who remained comatose after initial resuscitation.
The study did not provide specific data on the procedure’s ultimate effectiveness. It did, however, state that the number of patients who may benefit the most from induced hypothermia is limited and as yet underdetermined. That hasn’t stopped several state EM services from implementing the technique. Cities such as Seattle, Raleigh, Miami, and New York City have begun plans to train and equip its paramedics in using the cold saline approach.