KEEPING IT COOL
We wish to thank the outstanding efforts
of the Seattle Fire Department paramedics and the emergency physicians at
Harborview Medical Center, the providers
in the Wake County EMS System, and the
medical care teams of Rex Healthcare and
WakeMed Health and Hospitals.
al. Changing incidence of out-of-hospital
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4. Bernard SA, Smith K, Cameron P, et al. Induction
of therapeutic hypothermia by paramedics
after resuscitation from out of hospital ventricular fibrillation cardiac arrest: A randomised
controlled trial. Circulation. 2010;122( 7):737–742.
5. Rhee BJ, Zhang Y, Boddicker SA, et al. Effect of
hypothermia on transthoracic defibrillation in a
swine model. Resuscitaiton. 2005;65:79–85.
6. Boddicker SA, Zhang Y, Zimmerman MB, et al.
Hypothermia improves defibrillation success
and resuscitation outcomes from ventricular
fibrillation. Circulation. 2005;111( 3):195–201.
7. Wira C, Martin G, Stoner J, et al. Application
of normothermic cardiac arrest algorithms to
hypothermic cardiac arrest in a canine model.
8. Abella BS, Zhao D, Alvarado J, et al. Intra-arrest
cooling improves outcomes in a murine cardiac
arrest model. Circulation. 2004;109( 22):2786–2791.
9. Nozari A, Safar P, Stezoski S W, et al. Critical time
window for intra-arrest cooling with cold saline
flush in a dog model of cardiopulmonary resuscitation. Circulation. 2006;113( 23): 2,690– 2,696.
10.Kuboyama K, Safar P, Radovsky A, et al. Delay
in cooling negates the beneficial effect of mild
resuscitative cerebral hypothermia after cardiac arrest in dogs: A prospective, randomized
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11. Bernard SA, Gray T W, Buist MD, et al. Treatment
of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J
Med. 2002;346( 8):557–563.
12. Hypothermia after cardiac arrest study group.
A Wake County EMS crew works in a coordinated fashion to continue cooling of a patient after ROSC.
Francis Kim, MD, is an associate professor of medicine/neurology at the University of Washington
(UW) Harborview Medical Center. Contact him at
Michael K. Copass, MD, is medical director of the
Seattle Fire Department Medic One Program, medical director of the UW Paramedic Training Program
and professor of medicine/neurology at UW School
Brent Myers, MD, is director and medical director
of the Wake County EMS System in Raleigh, N.C. He
also serves as adjunct assistant professor of emergency medicine at the University of North Carolina
School of Medicine in Chapel Hill, N.C. Contact him at
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Mild therapeutic hypothermia to improve the
neurologic outcome after cardiac arrest. N Engl
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This clinical education feature appears as part
of the JEMS Integrated Clinical Training &
Simulation (ICTS) project sponsored by Laerdal
Medical Corp.’s Discover Simulation program,
with support from
JEMS and the