CARDIOPULMONARY RESUSCITATION: Edited by Fabio S. TacconeThe impact of intra-arrest hypothermiaNordberg, Pera; Annoni, Filippob; Taccone, Fabio S.bAuthor Information aDepartment of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden bDepartment of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium Correspondence to Per Nordberg, Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden. Tel: +46 70 280 25 79; e-mail: firstname.lastname@example.org Current Opinion in Critical Care: June 2020 - Volume 26 - Issue 3 - p 236-241 doi: 10.1097/MCC.0000000000000724 Buy Metrics Abstract Purpose of review To address the impact of therapeutic hypothermia induced already during cardiopulmonary resuscitation (i.e. intra-arrest cooling) and its association with neurologic functional outcome. Recent findings Intra-arrest cooling is superior than post-ROSC cooling to mitigate brain injuries in experimental models of cardiac arrest. The delayed initiation of hypothermia in human studies may not have adequately addressed the underlying pathophysiology of ischemia and reperfusion. The assessment of early initiation of cooling has been complicated by increased rate of hemodynamic adverse events caused by infusion of cold intravenous fluids. These adverse events have been more deleterious in patients with initial shockable rhythms. A recent randomized study shows that an alternative intra-arrest cooling method using trans-nasal evaporative cooling was well tolerated and effective to shorten time to target temperature. However, the neurologic outcomes (CPC 1–2 at 90 days) in favor of intra-arrest cooling compared to hospital cooling (34.8% vs 25.9%, P = 0.11) in patients with initial shockable rhythms did not reach statistical significance. Summary Therapeutic intra-arrest hypothermia can be initiated safely at the scene of the arrest using transnasal evaporative cooling. The potential beneficial effect of intra-arrest cooling on neurologic recovery in patients with initial shockable rhythms should be explored further. Copyright © 2020 YEAR Wolters Kluwer Health, Inc. All rights reserved.