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Prehospital cooling by cold infusion: searching for the optimal infusion regimen
  1. Roman Škulec1,2,
  2. Anatolij Truhlář2,3,
  3. Pavel Dostál2,
  4. Jana Šeblová1,
  5. Jiří Knor1,
  6. Gabriela Dostálová4,
  7. Štefan Škulec5,
  8. Vladimír Černý2,6
  1. 1Emergency Medical Service of the Central Bohemian Region, Kladno, Czech Republic
  2. 2Department of Anesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
  3. 3Hradec Kralove Region Emergency Medical Services, Hradec Kralove, Czech Republic
  4. 4IInd Department of Internal Cardiovascular Medicine, General Teaching Hospital, Prague, Czech Republic
  5. 5Slovak Hydrometeorological Institute, Bratislava, Slovak Republic
  6. 6Dalhousie University, Department of Anesthesia, Halifax, Canada
  1. Correspondence to Dr Roman Škulec, Emergency Medical Service of the Central Bohemian Region, Professor Veseleho 461, Beroun 266 01, Czech Republic; skulec{at}


Background The cooling efficacy of intravenous administration of cold crystalloids can be enhanced by optimisation of the procedure. This study assessed the temperature stability of different application regimens of cold normal saline (NS) in simulated prehospital conditions.

Methods Twelve different application regimens of 4°C cold NS (volumes of 250, 500 and 1000 ml applied at infusion rates of 1000, 2000, 4000 and 6000 ml/h) were investigated for infusion temperature changes during administration to an artificial detention reservoir in simulated prehospital conditions.

Results An increase in infusion temperature was observed in all regimens, with an average of 8.1±3.3°C (p<0.001). This was most intense during application of the residual 20% of the initial volume. The lowest rewarming was exhibited in regimens with 250 and 500 ml bags applied at an infusion rate of 6000 ml/h and 250 ml applied at 4000 ml/h. More intense, but clinically acceptable, rewarming presented in regimens with 500 and 1000 ml bags administered at 4000 ml/h, 1000 ml at 6000 ml/h and 250 ml applied at 2000 ml/h. Other regimens were burdened by excessive rewarming.

Conclusion Rewarming of cold NS during application in prehospital conditions is a typical occurrence. Considering that the use of 250 ml bags means the infusion must be exchanged too frequently during cooling, the use of 500 or 1000 ml NS bags applied at an infusion rate of ≥4000 ml/h and termination of the infusion when 80% of the infusion volume has been administered is regarded as optimal.

  • Prehospital cooling
  • cold normal saline
  • environmental medicine
  • hypothermia
  • nursing
  • prehospital
  • paramedics
  • effectiveness

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  • Funding This project was supported by a grant IGA MH CZ NS10383-2/2009 from the Ministry of Health of the Czech Republic and by a research project MZO 00179906 from the University Hospital Hradec Kralove.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.