All other procedures were similar to those used in the patients treated

with prehospital cooling including application of the cooling pads. The same protocol RG7420 for sedation, analgesia and neuromuscular blockade was used and cooling was continued for 24 h. Post-resuscitative care was provided according to established guidelines.31 Data were recorded as recommended for uniform reporting of data from out-of-hospital cardiac arrest.32 Also, number of both rearrests during the first 2 h after ROSC and episodes of pulmonary edema (as defined by reviewing admission chest radiograph reports) was recorded. Neurological outcome was classified by using the cerebral performance category (CPC). A performance score of 1 (good function) or 2 (moderate disability) on a 5-category scale was considered a favorable outcome; the other categories were considered an unfavorable outcome including 3 (severe disability), 4 (a vegetative state), and 5 (death). Patients with good recovery or moderate disability had sufficient cerebral function to live independently and work at least part-time in a sheltered environment. Patients dying during the ICU phase that were being sedated were categorized

as having unfavorable neurologic outcome. A specially trained study nurse assessed the 12-month follow up over the telephone. Time to ROSC, temperature on admission, time to target temperature (33.9 °C) and outcome were compared between groups. Continuous variables are reported as mean and standard deviation (SD) or median and interquartile range (IQRs; between the 25th and 75th quartiles), Bosutinib chemical structure if not normally distributed. Primary and secondary outcomes were binary, and the chi-square test was used to compare the outcomes between experimental groups. For normally distributed continuous variables, the Student’s t-test was performed. To C59 test non-normally distributed variables, the Kruskal–Wallis Test was used. For data management and analyses, MS Excel 2011 for Mac and Stata 13.1 for Mac (Stata Corp, College Station, TX) were used. A two-sided p-value < 0.05 was considered statistically significant. Between September 2005 and February 2010, overall 954 in-hospital

and out-of hospital cardiac arrest patients were treated at our department. From these, 787 (82.5%) achieved ROSC. From patients with ROSC, 585 (74.3%) were admitted after out of hospital-cardiac arrest and out of these, 110 patients were included in the study (Fig. 2). Out of 110, 56 (50.9%) were cooled in the prehospital setting and 54 (49.1%) were cooled after admission (IH) by using the external cooling pad (Table 1). The two patient groups did not differ in demographic characteristics except in a significantly longer time to first CPR attempts in the prehospital group (Table 1). In total, 20 patients cooled in the prehospital phase were not included: 5 patients did not achieve sustained ROSC and 15 patients were excluded due to cooling with other invasive and non-invasive techniques after admission to hospital.