Intraosseous infusion of ice cold saline is less efficacious than intravenous infusion for induction of mild therapeutic hypothermia in a swine model of cardiac arrest



      Intravenous (IV) infusion of ice cold saline is an effective method to initiate induction of mild therapeutic hypothermia (MTH) following resuscitation from out-of-hospital cardiac arrest (OOHCA). Intraosseous (IO) infusion of cold saline may be an alternative method to induce MTH.


      The goal of this study was to determine if IO infusion of cold saline is a comparable alternative to IV infusion for inducing MTH in a laboratory swine model of cardiac arrest.


      Ten mixed breed swine were resuscitated from cardiac arrest and randomized post-resuscitation to infusion with ice cold saline using either IO (n = 5) or IV (n = 5) access. The study endpoints were either a goal esophageal temperature of 34 °C or the elapse of a 30 min time period, simulating a long prehospital transport.


      Four of five pigs in the IV infusion group achieved goal temperature within 30 min compared to 0/5 in the IO infusion group (p = 0.048). The mean esophageal temperature change was significantly higher in the IV group when compared to the IO group (p < 0.001). Post-arrest hemodynamic parameters were similar between the two groups.


      IV infusion of ice cold saline is an efficacious method to achieve MTH in this swine model of cardiac arrest. Furthermore, IO infusion of cold saline is not sufficient to induce MTH in the time routinely available in the prehospital setting following OOHCA.


      To read this article in full you will need to make a payment


      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gaieski D.F.
        • Band R.A.
        • Abella B.S.
        • et al.
        Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest.
        Resuscitation. 2009; 80: 418-424
        • Bernard S.A.
        • Gray T.W.
        • Buist M.D.
        • et al.
        Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.
        N Engl J Med. 2002; 346: 557-563
        • Nikolov N.M.
        • Cunningham A.J.
        Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.
        N Engl J Med. 2002; 346: 549-556
        • Bruel C.
        • Parienti J.J.
        • Marie W.
        • et al.
        Mild hypothermia during advanced life support: a preliminary study in out-of-hospital cardiac arrest.
        Crit Care. 2008; 12: R31
        • Bernard S.
        • Buist M.
        • Monteiro O.
        • Smith K.
        Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report.
        Resuscitation. 2003; 56: 9-13
        • Virkkunen I.
        • Yli-Hankala A.
        • Silfvast T.
        Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer's solution: a pilot study.
        Resuscitation. 2004; 62: 299-302
        • Kim F.
        • Olsufka M.
        • Longstreth W.T.
        • et al.
        Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline.
        Circulation. 2007; 115: 3064-3070
        • Hammer L.
        • Vitrat F.
        • Savary D.
        • et al.
        Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest.
        Am J Emerg Med. 2009; 27: 570-573
        • Minville V.
        • Pianezza A.
        • Asehnoune K.
        • Carbardis S.
        • Smail N.
        Prehospital intravenous line placement assessment in the French emergency system: a prospective study.
        Eur J Anaesthesiol. 2006; 23: 594-597
        • Lapostolle F.
        • Catineau J.
        • Garrigue B.
        • et al.
        Prospective evaluation of peripheral venous access difficulty in emergency care.
        Intensive Care Med. 2007; 33: 1452-1457
        • Nolan J.P.
        • Deakin C.D.
        • Soar J.
        • Bottiger B.W.
        • Smith G.
        European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support.
        Resuscitation. 2005; 67: S39-S86
        • Fowler R.
        • Gallagher J.V.
        • Isaacs S.M.
        • Ossman E.
        • Pepe P.
        • Wayne M.
        The role of intraosseous vascular access in the out-of-hospital environment (resource document to NAEMSP position statement).
        Prehosp Emerg Care. 2007; 11: 63-66
        • Seigler R.S.
        • Tecklenburg F.W.
        • Shealy R.
        Prehospital intraosseous infusion by emergency medical services personnel: a prospective study.
        Pediatrics. 1989; 84: 173-177
        • Fuchs S.
        • LaCovey D.
        • Paris P.
        A prehospital model of intraosseous infusion.
        Ann Emerg Med. 1991; 20: 371-374
        • Larabee T.M.
        • Paradis N.A.
        • Bartsch J.
        • Cheng L.
        • Little C.
        A swine model of pseudo-pulseless electrical activity induced by partial asphyxiation.
        Resuscitation. 2008; 78: 196-199
        • Mader T.J.
        The effect of ambient temperature on cold saline during simulated infusion to induce therapeutic hypothermia.
        Resuscitation. 2009; 80: 766-768
        • Warren D.W.
        • Kissoon N.
        • Sommerauer J.F.
        • Rieder M.J.
        Comparison of fluid infusion rates among peripheral intravenous and humerus, femur, malleolus, and tibial intraosseous sites in normovolemic and hypovolemic piglets.
        Ann Emerg Med. 1993; 22: 183-186
        • Mader T.J.
        • Walterscheid J.K.
        • Kellogg A.R.
        • Lodding C.C.
        The feasibility of inducing mild therapeutic hypothermia after cardiac resuscitation using iced saline infusion via an intraosseous needle.
        Resuscitation. 2010; 81: 82-86