Evidence map›Paper›PMID 27562972›Full record

Trial reportCirculation2016

Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline: The RINSE Trial (Rapid Infusion of Cold Normal Saline).

Stephen A Bernard, Karen Smith, Judith Finn, Cindy Hein, Hugh Grantham, Janet E Bray, Conor Deasy, Michael Stephenson, Teresa A Williams, Lahn D Straney and 4 more

Registry-linked trialOpen access · bronzeAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Circulation, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01173393 (The RINSE Trial), which is not on this map. Cited by 65 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
65citing papers in PubMed, 11 pooled it
15.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01173393 phase3completednot on this map

The RINSE Trial: Rapid Infusion of Cold Saline During CPR for Patients With Cardiac Arrest

TypeinterventionalSponsorAmbulance VictoriaRan2010 to 2014Enrolled1,220ConditionsOut-of-hospital Cardiac ArrestArmsPARAMEDIC COOLING
3 · Its place in the literature

Who cites it

65 citing papers in PubMed, 11 syntheses or guidelines pooled it, 167 citations in OpenAlex.

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  13. Pre-hospital freeze-dried plasma for critical bleeding after trauma: A pilot randomized controlled trial.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2023
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  19. Effects ofResuscitation plus · 2026
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5 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 3 institutions in 1 country.

Stephen A BernardFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.). steve.bernard@ambulance.vic.gov.au.
Karen SmithFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Judith FinnFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Cindy HeinFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Hugh GranthamFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Janet E BrayFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Conor DeasyFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Michael StephensonFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Teresa A WilliamsFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Lahn D StraneyFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Deon BrinkFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Richard LarsenFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Chris CottonFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Peter CameronFrom Ambulance Victoria, Doncaster, Victoria, Australia (S.A.B., K.S., M.S.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.A.B., K.S., J.F., J.E.B., C.D., M.S., L.D.S., P.C.); Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.F., J.E.B., T.A.W., D.B.); St. John Ambulance Western Australia, Perth, Western Australia, Australia (J.F., D.B.); SA Ambulance Service, Adelaide, South Australia, Australia (C.H., H.G., R.L., C.C.); Paramedic Unit, Flinders University, Adelaide, South Australia, Australia (C.H., H.G.); and Cork University Hospital, Wilton, Cork, Ireland (C.D.).
Curtin University · AUAmbulance Victoria · AUFlinders University · AU

Funding

MRC 1010613MRC 1069985MRC 545926
6 · The paper itself

Abstract

backgroundPatients successfully resuscitated by paramedics from out-of-hospital cardiac arrest often have severe neurologic injury. Laboratory and observational clinical reports have suggested that induction of therapeutic hypothermia during cardiopulmonary resuscitation (CPR) may improve neurologic outcomes. One technique for induction of mild therapeutic hypothermia during CPR is a rapid infusion of large-volume cold crystalloid fluid.

methodsIn this multicenter, randomized, controlled trial we assigned adults with out-of-hospital cardiac arrest undergoing CPR to either a rapid intravenous infusion of up to 2 L of cold saline or standard care. The primary outcome measure was survival at hospital discharge; secondary end points included return of a spontaneous circulation. The trial was closed early (at 48% recruitment target) due to changes in temperature management at major receiving hospitals.

resultsA total of 1198 patients were assigned to either therapeutic hypothermia during CPR (618 patients) or standard prehospital care (580 patients). Patients allocated to therapeutic hypothermia received a mean (SD) of 1193 (647) mL cold saline. For patients with an initial shockable cardiac rhythm, there was a decrease in the rate of return of a spontaneous circulation in patients who received cold saline compared with standard care (41.2% compared with 50.6%, P=0.03). Overall 10.2% of patients allocated to therapeutic hypothermia during CPR were alive at hospital discharge compared with 11.4% who received standard care (P=0.71).

conclusionsIn adults with out-of-hospital cardiac arrest, induction of mild therapeutic hypothermia using a rapid infusion of large-volume, intravenous cold saline during CPR may decrease the rate of return of a spontaneous circulation in patients with an initial shockable rhythm and produced no trend toward improved outcomes at hospital discharge. CLINICAL

trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01173393.

Indexed as

AgedAged, 80 and overCardiopulmonary ResuscitationHumansHypothermia, InducedIsotonic SolutionsMiddle AgedOut-of-Hospital Cardiac ArrestIsotonic Solutionscardiac arrestcardiopulmonary resuscitationclinical trialemergency medical servicestherapeutic hypothermia

Identifiers

PMID27562972
OpenAlexW2519185513

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.