First UK Evaluation of Continuous Targeted Brain Cooling In Cardiac Arrest From Street To ITU

Rhinochill brain cooling deviceFor the first time in the UK, the RhinoChill® IntraNasal Cooling System is being jointly evaluated by an ambulance service and hospital to assess the effect of continuous targeted brain cooling in cardiac arrest patients, from the time they are attended by paramedics at the scene of the event until they arrive in the hospital’s Intensive Therapy Unit (ITU).


It is widely believed that cooling the brain following cardiac arrest can improve survival chances and also minimise any long-term neurological damage. Some UK ambulance services currently use various methods of initiating the cooling process before the patient reaches hospital, such as cold saline drips and cooling pads. However, these methods do not directly target the brain, relying instead on cooling the whole body and blood to indirectly achieve this effect. Many hospitals within the UK wait until the patient reaches the ITU before cooling is commenced, but some are also moving cooling into the Accident and Emergency (A&E) Department.

RhinoChill is a device which rapidly and effectively reduces brain temperature by spraying an evaporating coolant liquid up the nose and into the nasal cavity, a large area situated close to the brain which acts as a heat exchanger. As it is both easy-to-use and portable, RhinoChill can be carried by paramedics and its use initiated as soon as they get to the patient. Once the hospital is reached, the device can simply be hooked up to the stretcher, then continue to cool the patient to the correct brain temperature during further treatment and assessments in the A&E Department. As soon as the target temperature has been reached, the patient is then transferred onto hospital cooling devices for the remainder of the 24 hour cooling treatment.

This integrated evaluation, which is being jointly conducted by the South East Coast Ambulance Service NHS Foundation Trust (SECAmb) and the A&E Department at Royal Sussex County Hospital in Brighton, is involving a total of 25 cardiac arrest patients, in whom RhinoChill treatment is being initiated by Critical Care Paramedics as soon as ROSC (Return Of Spontaneous Circulation) has occurred. Brain cooling with RhinoChill is then being maintained until the patient is transferred to a maintenance cooling system in the ITU.

The evaluation is assessing the ease of use of the system in a UK Ambulance Service, time it takes to reduce the patient’s brain temperature to the optimal range of 32-34°C, the number of days the patient spends in intensive care, the percentage of patients surviving to discharge from hospital, and the neurological status of surviving patients at their discharge.

Four patients have already been enrolled in the evaluation, which is likely to take around six months to complete.

Physician comments

“The results of this evaluation should be extremely useful for SECAmb and all ambulance services, as we strive to provide the very best care for our patients. We are excited to be the first UK ambulance service able to cool a cardiac arrest patient’s brain while still at the scene, and know that we have played our part in giving them the best chance possible for a good recovery”, commented Professor Andy Newton, SECAmb Consultant Paramedic & Director of Clinical Operations.

“We will be particularly interested in the results of this evaluation from a hospital perspective”, added Dr Rob Galloway, Accident and Emergency Consultant at Royal Sussex County Hospital. “It’s an excellent example of two separate NHS organisations co-operating to streamline a vital process of patient management, thereby improving patient care.”

Source: Benechill International SA