Using Esophageal Temperature Management to Treat Severe Heat Stroke: A Case Report

Abstract

BACKGROUND: Exertional heat stroke (EHS) is defined by a core body temperature that exceeds 40°C with associated central nervous system dysfunction, skeletal muscle injury, and multiple organ damage. The most important initial focus of treatment involves reduction of patient temperature. First approaches to achieve temperature reduction often include ice packs, water blankets, and cold intravenous fluid administration. When these measures fail, more advanced temperature management methods may be deployed but often require surgical expertise. Esophageal temperature management (ETM) has recently emerged as a new temperature management modality in which an esophageal heat transfer device replaces the standard orogastric tube routinely placed after endotracheal intubation and adds a temperature modulation capability. The objective of this case study is to report the first known use of ETM driven by bedside nursing staff in the treatment of EHS. METHOD: An ETM device was placed after endotracheal intubation in a 28-year-old man experiencing EHS over a 5-day course of treatment. RESULTS: Because the ETM device was left in place, when the patient experienced episodes of increasing temperature as high as 39.1°C, which required active cooling, nursing staff were able to immediately adjust the external heat exchange unit settings to achieve aggressive cooling at bedside. CONCLUSION: This nurse-driven technology offers a new means to rapidly deploy cooling to critically ill patients without needing to implement advanced surgical approaches or obstruct access to the patient, freeing the provider to continue optimal care in highmorbidity conditions.

Core warming of coronavirus disease 2019 (COVID-19) patients undergoing mechanical ventilation – a protocol for a randomized controlled pilot study

“…Core temperature control and warming will be performed with a commercially available esophageal heat exchange device (ensoETM, Attune Medical, Chicago, IL). This device is currently used world-wide for various patient temperature management goals, including postcardiac arrest therapeutic hypothermia, [44][45][46][47] warming of burn patients, [48] warming general surgical patients, [49] cooling traumatic brain injury, [50] cooling heat stroke, [51] and the treatment of central fever. [52,53] The device is a multi-chambered silicone tube placed in the esophagus and connected to a heat exchanger to provide heat transfer to or from a patient (video available at https://vimeo.com/306506411).…”

Core warming of coronavirus disease 2019 (COVID-19) patients undergoing mechanical ventilation—A protocol for a randomized controlled pilot study

“…Core temperature control and warming will be performed with a commercially available esophageal heat exchange device (ensoETM, Attune Medical, Chicago, IL). This device is currently used world-wide for various patient temperature management goals, including post-cardiac arrest therapeutic hypothermia [53][54][55][56], warming of burn patients [57], warming general surgical patients [58], cooling traumatic brain injury [59], cooling heat stroke [60], and the treatment of central fever [61,62]. The device is a multi-chambered silicone tube placed in the esophagus and connected to a heat exchanger to provide heat transfer to or from a patient (video available at https://vimeo.com/306506411).…”

The Use of Core Warming as a Treatment for Coronavirus Disease 2019 (COVID-19): an Initial Mathematical Model

“…A core heat trasnfer device (ensoETM, Attune Medical, Chicago, IL) has been commercially available for several years and is used for a range of temperature management purposes, including postcardiac arrest therapeutic hypothermia [31][32][33][34] , warming of burn patients 35 , warming general surgical patients 36 , cooling traumatic brain injury 37 , cooling heat stroke 38 , and the treatment of central fever 39,40 . The device is a multichambered silicone tube placed in the esophagus and connected to a heat exchanger to provide heat transfer to or from a patient 41 .…”