Nordberg, PerTaccone, Fabio SilvioTruhlar, AnatolijForsberg, SuneHollenberg, JacobJonsson, MartinCuny, JeromeGoldstein, PatrickVermeersch, NickHiguet, AdelineJiménes, Francisco CarmonaOrtiz, Fernando RosellWilliams, JuliaDesruelles, DidierCreteur, JacquesDillenbeck, EmelieBusche, CarolineBusch, Hans-JörgRingh, MattiasKonrad, DavidPeterson, JohanVincent, Jean-LouisSvensson, Leif2023-01-252023-01-252019http://hdl.handle.net/10668/13922Therapeutic 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.enAgedBrainBrain InjuriesCardiopulmonary ResuscitationEmergency Medical ServicesEpistaxisFemaleHumansHypothermia, InducedMaleMiddle AgedOut-of-Hospital Cardiac ArrestSample SizeSingle-Blind MethodSurvival RateTime-to-TreatmentTreatment Outcomeresearch article31063573open access10.1001/jama.2019.41491538-3598PMC6506882https://jamanetwork.com/journals/jama/articlepdf/2732572/jama_nordberg_2019_oi_190036.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506882/pdf