I have written before about the beneficial effects of cooling the brain on survival and neurological recovery after a cardiac arrest. It has been shown that the sooner the cooling is started and the sooner the target temperature is achieved the better the outcome.

I have started intravascular cooling in the Intensive Care Unit on multiple occasions. If started in the ICU, then the cooling is may sometimes be delayed by more than an hour and the benefit of it is likely greatly reduced.

Starting cooling as early as possible, ideally, at the scene of cardiac arrest should be out ultimate goal.

Realizing, of course, this is easier said then done. Imagine paramedics trying to intubate the patient, perform CPR, establish peripheral access, transport the patient at the same time and, somehow, initiate cooling.

It could only be done if the induction of cooling was easy to perform on the field and efficient enough to have a measurable benefit on survival.

One of the methods is to start infusing cold saline through a peripheral IV. This could be done by paramedics and continued in the Hospital.

A novel technique, which we previously described, is to use a rapidly evaporating substance to cool the mucous membrane inside the nose and throat of the cardiac arrest victim.

The proximity of the nose to the brain and the shared blood supply between the nasopharynx and the brain makes it an “ideal” candidate for induction of hypothermia.

A recent study published in the Critical Care Medicine Journal compares two cooling methods (nasopharyngeal cooling vs. cold saline infusion) in porcine model of cardiac arrest. Both were initiated at the start of CPR.

The study concluded that nasopharyngeal cooling (NPC) initiated at the start of CPR significantly improved the resuscitation rate when compared with cold saline infusion.

After all is said and done, your nose might become a “vital organ” to save your life if you ever go into cardiac arrest.

Reviewing recent medical literature, I came across an interesting study from Europe. The investigators in several European cities were using an intranasal cooling device to cool the patients having cardiac arrest. I am myself very interested in cooling cardiac arrest patients. There is a body of evidence that the patients have better neurological outcomes when therapeutic hypothermia (cooling to 32 – 33 degrees Celsius) is utilized. I have been using an intravascular cooling system in my ICU. When cooling is being initiated in ICU, there is always a delay in time. The sooner this treatment is started the better our chances on preserving the neurological function. Ideally, the cooling should be initiated immediately at the scene. Using cooling packs and cold saline is somewhat cumbersome and might interfere with the resuscitation. A company from San Diego came up with an intranasal cooling device called RhinoChill to provide cooling immediately after the cardiac arrest. It sprays a rapidly evaporating chemical onto nasal mucous membrane, thus, cooling it down. It does make sense physiologically. The inner surface of the nose is reach in vascular supply and it’s proximity to the brain makes it an ‘ideal’ place for cooling. The data is promising so far. If it goes mainstream, we might see it next to the cardiac defibrillators at the airports (just kidding).