Rapid induction of therapeutic hypothermia using convective-immersion surface cooling: Safety, efficacy and outcomes

Abstract

Therapeutic hypothermia has become an accepted part of post-resuscitation care. Efforts to shorten the time from return of spontaneous circulation to target temperature have led to the exploration of different cooling techniques. Convective-immersion uses a continuous shower of 2°C water to rapidly induce hypothermia. The primary purpose of this multi-center trial was to evaluate the feasibility and speed of convective-immersion cooling in the clinical environment. The secondary goal was to examine the impact of rapid hypothermia induction on patient outcome. 24 post-cardiac arrest patients from 3 centers were enrolled in the study; 22 agreed to participate until the 6-month evaluations were completed. The median rate of cooling was 3.0°C/h. Cooling times were shorter than reported in previous studies. The median time to cool the patients to target temperature (<34°C) was 37 min (range 14–81 min); and only 27 min in a subset of patients sedated with propofol. Survival was excellent, with 68% surviving to 6 months; 87% of survivors were living independently at 6 months. Conductive-immersion surface cooling using the ThermoSuit® System is a rapid, effective method of inducing therapeutic hypothermia. Although the study was not designed to demonstrate impact on outcomes, survival and neurologic function were superior to those previously reported, suggesting comparative studies should be undertaken. Shortening the delay from return of spontaneous circulation to hypothermic target temperature may significantly improve survival and neurologic outcome and warrants further study.

Hypothermia Therapy

“…The currently available cooling methods have been largely developed in the setting of post-cardiac arrest comatose survivors and are detailed in the following text (82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95)(96). Cold infusion.…”

The Effects of Local and General Hypothermia on Temperature Profiles of the Central Nervous System Following Spinal Cord Injury in Rats

“…Moderate-to-mild general hypothermia comprises core temperatures in the range of 30-35°C, which can be induced in the clinic by whole-body cooling pads or immersion in cold water (Howes et al, 2010). A study conducted by Polderman et al (2002) tested the effect of hypothermia treatment on 64 patients with severe head injury.…”

Therapeutic Hypothermia for Acute Neurological Injuries

“…The automated cold water immersion Thermosuit System (Life Recovery Systems, Kinnelon, NJ) works by the convective-immersion mechanism and circulates ice water from a perforated top-sheet and an under-blanket across the skin surface at a rate of 14 L/min [78]. In a swine study, it has been shown to achieve target temperature of 33°C in 9 minutes.…”