Please select the eligibility criteria that correspond to the clinical trial below.
Title: PRINCESS - Prehospital Resuscitation Intra Nasal Cooling Effectiveness Survival Study
Brief Summary: Promising result of intra-arrest cooling on neurological intact survival in cardiac arrest patients has recently been published in the PRINCE-study in Circulation 2010.

The main purpose of this study is to determine whether prehospital intra-nasal cooling initiated during resuscitation, in addition to systemic cooling at hospital, increases neurological intact survival measured as cerebral performance category score (CPC-score)at 90 days in witnessed cardiac arrests outside hospital.


Options:
A: Inclusion Criteria:

* ≥18 years
* Collapse was witnessed
* No pulse
* Unresponsive to external stimuli

Exclusion Criteria:

* Have an etiology of cardiac arrest due to trauma, severe bleeding, drug overdose (OD), cerebrovascular accident (CVA), drowning, smoke inhalation, electrocution, hanging
* Already hypothermic
* Head trauma
* Cannot place intra nasal catheters
* Do Not Attempt to Resuscitate (DNAR) orders
* Known or clinically apparent pregnancy
* Have a known coagulopathy (except therapeutically induced)
* Are known to have a need for supplemental oxygen
* Achieve return of spontaneous circulation (ROSC) prior to initiating cooling
* Are reached by emergency medical services (EMS) personnel more than 20 minutes after collapse
B: Inclusion Criteria:

* successful resuscitation from out-of-hospital cardiac arrest by paramedics, defined by having a palpable pulse

Exclusion Criteria:

* traumatic cause for cardiac arrest
C: Inclusion Criteria:

* Age ≥18 years
* Collapse was witnessed (heard or seen)
* Do not have a pulse
* Are unresponsive to external stimuli

Exclusion Criteria:

* Age ≥80 years
* Have an etiology of cardiac arrest due to trauma, severe bleeding, drug overdose, cerebrovascular accident, drowning, smoke inhalation, electrocution, hanging
* Already hypothermic (e.g., avalanche victim; found in the snow)
* Have an obvious barrier to placing intra nasal catheters (e.g., intranasal obstruction)
* Do Not Attempt to Resuscitate (DNAR) orders
* Have a terminal disease
* Known or clinically apparent pregnancy
* Have a known coagulopathy (except therapeutically induced)
* Are known to have a need for supplemental oxygen
* Achieve ROSC prior to randomization
* Response time (call to arrival) of the ambulance \> 15 minutes
D: Inclusion Criteria:

* Age ≥ 18 years old
* Out-of-hospital cardiac arrest (OHCA) of presumed cardiac cause
* Return of spontaneous circulation (ROSC)
* Unconsciousness (Glasgow Coma Score \< 8) (patients not able to obey verbal commands)after sustained ROSC

Exclusion Criteria:

* In-hospital cardiac arrest
* OHCA of presumed non-cardiac cause, e.g. after trauma or dissection/rupture of major artery OR Cardiac arrest caused by initial hypoxia (i.e. drowning, suffocation, hanging).
* Known bleeding diathesis (medically induced coagulopathy (e.g warfarin, clopidogrel) does not exclude the patient).
* Suspected or confirmed acute intracranial bleeding
* Suspected or confirmed acute stroke
* Unwitnessed asystole
* Known limitations in therapy and Do Not Resuscitate-order
* Known disease making 180 days survival unlikely
* Known pre-arrest CPC 3 or 4
* Temperature \< 30°C on admission
* \> 4 hours (240 minutes) from ROSC to screening
* Systolic blood pressure \< 80 mm Hg in spite of fluid loading/vasopressor and/or inotropic medication/intra aortic balloon pump#

  * If the systolic blood pressure (SBP) is recovering during the inclusion window (220 minutes) the patient can be included.

Answer: C