%0 Journal Article
%A Nordberg, Per
%A Taccone, Fabio Silvio
%A Truhlar, Anatolij
%A Forsberg, Sune
%A Hollenberg, Jacob
%A Jonsson, Martin
%A Cuny, Jerome
%A Goldstein, Patrick
%A Vermeersch, Nick
%A Higuet, Adeline
%A Jiménes, Francisco Carmona
%A Ortiz, Fernando Rosell
%A Williams, Julia
%A Desruelles, Didier
%A Creteur, Jacques
%A Dillenbeck, Emelie
%A Busche, Caroline
%A Busch, Hans-Jörg
%A Ringh, Mattias
%A Konrad, David
%A Peterson, Johan
%A Vincent, Jean-Louis
%A Svensson, Leif
%T Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital Cardiac Arrest: The PRINCESS Randomized Clinical Trial.
%D 2019
%U http://hdl.handle.net/10668/13922
%X Therapeutic hypothermia may increase survival with good neurologic outcome after cardiac arrest. Trans-nasal evaporative cooling is a method used to induce cooling, primarily of the brain, during cardiopulmonary resuscitation (ie, intra-arrest). To determine whether prehospital trans-nasal evaporative intra-arrest cooling improves survival with good neurologic outcome compared with cooling initiated after hospital arrival. The PRINCESS trial was an investigator-initiated, randomized, clinical, international multicenter study with blinded assessment of the outcome, performed by emergency medical services in 7 European countries from July 2010 to January 2018, with final follow-up on April 29, 2018. In total, 677 patients with bystander-witnessed out-of-hospital cardiac arrest were enrolled. Patients were randomly assigned to receive trans-nasal evaporative intra-arrest cooling (n = 343) or standard care (n = 334). Patients admitted to the hospital in both groups received systemic therapeutic hypothermia at 32°C to 34°C for 24 hours. The primary outcome was survival with good neurologic outcome, defined as Cerebral Performance Category (CPC) 1-2, at 90 days. Secondary outcomes were survival at 90 days and time to reach core body temperature less than 34°C. Among the 677 randomized patients (median age, 65 years; 172 [25%] women), 671 completed the trial. Median time to core temperature less than 34°C was 105 minutes in the intervention group vs 182 minutes in the control group (P  Among patients with out-of-hospital cardiac arrest, trans-nasal evaporative intra-arrest cooling compared with usual care did not result in a statistically significant improvement in survival with good neurologic outcome at 90 days. ClinicalTrials.gov Identifier: NCT01400373.
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