The introduction of an esophageal heat transfer device into a therapeutic hypothermia protocol: A prospective evaluation

Markota, Andrej; Fluher, Jure; Kit, Barbara; Balažič, Petra; Sinkovič, Andreja

doi:10.1016/j.ajem.2016.01.028

Cited by 33 publications

(26 citation statements)

References 27 publications

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“…Accordingly, cooling rates in the present study met the recommendations of rapid cooling with cooling rates between 2.8 and 3.0°C/h. However, we must not forget the fact that this was an experimental study with an average body weight of 27-30kg, which is approximately half of that used in the studies of Markota and Kulstad [15, 23]. Eventually, extrapolation of data of this study to experimental and clinical cooling rates is difficult, which is a limitation of this study.…”

Section: Discussionmentioning

confidence: 93%

“…Scientific evidence hints towards neuroprotection by rapid cooling after OHCA with 1–2°C/h [12]. Recently, Markota et al reported a cooling rate of 1.12°C/h in a prospective evaluation of OHE after OHCA [23]. A cooling rate of 1.3°C/h was reached by OHE in an experimental study in pigs that did not suffer cardiac arrest but underwent a TTM-protocol [15].…”

Section: Discussionmentioning

confidence: 99%

“…To provide similar conditions during the rewarming period to the TTM-protocol used in our hospital, pigs were covered with a silver blanket known to decrease the incidence of shivering and passively increase the patient´s skin temperature [24]. However, accurate rewarming of approximately 0.25°C/h could also be confirmed experimentally by use of OHE in other studies [15–17, 23]. Interestingly, in two preceding studies in humans, preventing perioperative hypothermia with OHE was ineffective during hip [25] and abdominal surgery [26].…”

Section: Discussionmentioning

confidence: 99%

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Oesophageal heat exchangers with a diameter of 11mm or 14.7mm are equally effective and safe for targeted temperature management

et al. 2017

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BackgroundTargeted temperature management (TTM) is widely used in critical care settings for conditions including hepatic encephalopathy, hypoxic ischemic encephalopathy, meningitis, myocardial infarction, paediatric cardiac arrest, spinal cord injury, traumatic brain injury, ischemic stroke and sepsis. Furthermore, TTM is a key treatment for patients after out-of-hospital cardiac-arrest (OHCA). However, the optimal cooling method, which is quick, safe and cost-effective still remains controversial. Since the oesophagus is adjacent to heart and aorta, fast heat-convection to the central blood-stream could be achieved with a minimally invasive oesophageal heat exchanger (OHE). To date, the optimal diameter of an OHE is still unknown. While larger diameters may cause thermal- or pressure-related tissue damage after long-term exposure to the oesophageal wall, smaller diameter (e.g., gastric tubes, up to 11mm) may not provide effective cooling rates. Thus, the objective of the study was to compare OHE-diameters of 11mm (OHE11) and 14.7mm (OHE14.7) and their effects on tissue and cooling capability.MethodsPigs were randomized to OHE11 (N = 8) or OHE14.7 (N = 8). After cooling, pigs were maintained at 33°C for 1 hour. After 10h rewarming, oesophagi were analyzed by means of histopathology. The oesophagus of four animals from a separate study that underwent exactly the identical preparation and cooling protocol described above but received a maintenance period of 24h were used as histopathological controls.ResultsMean cooling rates were 2.8±0.4°C°C/h (OHE11) and 3.0±0.3°C °C/h (OHE14.7; p = 0.20). Occasional mild acute inflammatory transepithelial infiltrates were found in the cranial segment of the oesophagus in all groups including controls. Deviations from target temperature were 0.1±0.4°C (OHE11) and 0±0.1°C (OHE14.7; p = 0.91). Rewarming rates were 0.19±0.07°C °C/h (OHE11) and 0.20±0.05°C °C/h (OHE14.7; p = 0.75).ConclusionsOHE with diameters of 11 mm and 14.7 mm achieve effective cooling rates for TTM and did not cause any relevant oesophageal tissue damage. Both OHE demonstrated acceptable deviations from target temperature and allowed for an intended rewarming rate (0.25°C/h).

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Oesophageal heat exchangers with a diameter of 11mm or 14.7mm are equally effective and safe for targeted temperature management

et al. 2017

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“…The novel esophageal cooling device helps to achieve rapid induction in patients with post cardiac arrest [103]. According to its noninvasive property, it is also feasible for fever control in intensive care unit [104].…”

Section: The Novel Cooling Methodsmentioning

confidence: 99%

Targeted Temperature Management in Traumatic Brain Injury

Muengtaweepongsa¹,

Yodwisithsak²

2018

Traumatic Brain Injury - Pathobiology, Advanced Diagnostics and Acute Management

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Traumatic brain injury (TBI) remains an important health problem worldwide. Patho physiology of TBI has been intensively investigated. Many novel theories related with pathophysiology of TBI have been regularly proposed. Targeted temperature management (TTM), previously known as therapeutic hypothermia, has a well-established benefit for application as neuroprotective therapy and intracranial pressure (ICP) control. With the novel automatic feedback machine, application of TTM in clinical practice becomes much feasible and safe. Many preclinical trials of TTM in models with TBI demonstrated useful ness in multiple aspects. The successful story of TTM in patients with restore of spontaneous circulation (ROSC) after cardiac arrest is a good example for bench to bedside. In the past decade, many clinical trials of TTM in patients with TBI have been conducted with the hope to be another successful study.

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“…Mathematical models and animal studies strongly support the efficacy and safety of the ECD [11][12][13]. In 2 series recently published, potential side-effects of ECD were not precisely evaluated [14,15]. Additionally, ECD was always associated with other cooling methods such as the use of large volume of cold fluids, despite that this cooling method is no longer recommended according to recent international guidelines [16].…”

Section: Introductionmentioning

confidence: 99%

Targeted temperature management using the “Esophageal Cooling Device” after cardiac arrest (the COOL study): A feasibility and safety study

et al. 2017

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The introduction of an esophageal heat transfer device into a therapeutic hypothermia protocol: A prospective evaluation

Abstract: Using the EHTD, our patient population attained goal temperatures in one hour, the volume of ice-cold saline required to attain this cooling rate was decreased by one-third, and experienced a low percentage of time outside target temperature range and no major adverse effects.

Cited by 33 publications

References 27 publications

Oesophageal heat exchangers with a diameter of 11mm or 14.7mm are equally effective and safe for targeted temperature management

Oesophageal heat exchangers with a diameter of 11mm or 14.7mm are equally effective and safe for targeted temperature management

Targeted Temperature Management in Traumatic Brain Injury

Targeted temperature management using the “Esophageal Cooling Device” after cardiac arrest (the COOL study): A feasibility and safety study

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