Have used cooling blankets, cold saline, and endovascular devices- in different set ups.

Intuitively the endovascular devices do a precise job; but two of our patients got VTE.

The type of blanket would affect the efficacy - "the Arctic sun" worked well  too; slower than the endovascular one.

In pre-hosiptal settings usually cool-packs are easy to use, spreading them over head, axiallies and trunk etc.. Though this is quite an unsophisticated method and hard to control, it does a good job when there is not much time to waste.

We use cooling pads with skin-friendly adhesive (Arctic sun(r)) and prefer them to endovascular approach because of a better risk-benefit-ratio. For really fast cooling we are keeping isotonic cristallines not only in our fridge (4-8°C) but also infuse them.

In Montpellier (France) we use " cool packs" in pre hospital transport, is very simple and easy to use , they are fixed around the chest and sometimes one in abdominal position , the temperature is monitored by an electronic scope ( rectal or oesophagus temperature )

30 ml/kg up to 2 litres rapid infusion cold (4 degrees C) saline .

http://www.med.monash.edu.au/epidemiology/traumaepi/rinse.html

http://www.ncbi.nlm.nih.gov/pubmed/21995804

In my country use cold saline after ROSC. It can be use from the cool-box of the ambulance car.  At present is not general rule for the use.

Extrernal cooling devices: Blankets a Pads; and duriong cooling induction we also used 1-2 liters of cool saline solution, infused quickly.

I’ll preface this by emphasizing that I do have a conflict of interest with one of these devices, but my thoughts on the 3 approaches we use at my hospital are as follows.

Surface approaches using standard water blankets typically don’t give the control over patient temperature (in terms of cooling, maintaining stability at goal temperature, and rewarming rate) that the nurses prefer to have (when temperatures are fluctuating significantly, nursing workload inevitably increases as they try to address each swing in temperature). 

Surface approaches using more advanced technology (gel pads that increase the ability to transfer heat across the skin), offer improved performance over water blankets, but still have cases where temperature fluctuation around goal temperature can be significant.  Since the thermal conductivity of skin changes dramatically with temperature (becoming very low as temperature drops), it is not unexpected that there will be difficulties transferring heat across the skin.  And of course the other issue that we seem to see more frequently with surface approaches is shivering.  Our site leaves the choice of temperature (33 C or 36 C target) up to the treating clinicians, so we’re seeing both (typically using colder target for more neurologically devastated patients, and warmer 36 C target for less neurologically injured patients, similar to those described in the TTM3336 trial by Nielsen et al., or for those with contraindications to going colder).  At the 36 C target, it seems that there’s even more shivering than at the 33 C target. 

We also have the intravascular cooling catheters, but despite their better performance, have used them less since the introduction of the advanced surface approach, primarily due to the fact that it’s just easier for the docs to leave the placement of the device to nursing staff.  We’re also under a bit more pressure to avoid placing a central line if one is not expressly needed, since new CLABSI reporting guidelines went into effect earlier this year. 

A newer approach (that I’ve helped develop, and therefore do have a conflict of interest with) is an esophageal heat transfer approach, that works similarly to the idea of gastric lavage, but that doesn’t require instillation of any free liquid into the GI tract, and that uses existing water blanket chillers for power and servo control of patient temperature.  Initial reports on its use in hypothermia and fever reduction are here: http://www.resuscitationjournal.com/article/S0300-9572(15)00050-7/abstract and http://www.ccforum.com/content/19/S1/P424

http://www.resuscitationjournal.com/article/S0300-9572(15)00050-7/abstract

http://www.ccforum.com/content/19/S1/P424

Thanks a lot to you all. That gives me a clue about what is going on elsewhere. 

We use Rhino-chill after ROSC.