Central diabetes insipidus in post-cardiac arrest patients treated with therapeutic hypothermia

Abstract

Purpose of the study: To evaluate the performance of esophageal heat transfer device (EHTD) in inducing, maintaining, and reversing therapeutic hypothermia in adult survivors of cardiac arrest. Materials and methods: We performed a prospective, interventional study from March to May 2015. EHTD (Esophageal Cooling Device, Advanced Cooling Therapy, Chicago, IL, USA) was inserted after admission and connected to chiller (CritiCool, MTRE, Rehovot, Israel). Study protocol was to achieve target temperature (32–34 ◦C in urinary bladder) within 1h after admission, maintain it until 24h after admission and rewarm to 36 ◦C at a rate 0.25–0.5 ◦C/h. Iced saline infusionduring induction (1000ml for initial temperature 34.1–35 ◦C and 20ml/kg if ≥35.1 ◦C) and external cooling/rewarming during maintenance and rewarming (for temperature outside the desired range for ≥2h) were allowed. Minor fluctuations were defined as <0.5 ◦C outside the desired range. Results:We included 13 patients, 12 (92%)males.Mean agewas 65±14years,weight 79±17kg (range56–126kg), initial temperature 35.1±1.1 ◦C, time to target temperature 99±96min, and iced saline volume during induction 1538±853ml. Target temperature was reached in all patients andmaintained within desired range in 6. Minor fluctuations occurred in 4 and unwanted rewarming in 3 patients (in these 3 patients external cooling and neuromuscular blocking agents were used additionally). Mean rate of rewarming was 0.3±0.1 ◦C/h. Rewarming with EHTD was unsuccessful in one patient (external rewarming used, the patient died after 4 days in cardiogenic shock and multiorgan failure). Conclusion: EHTD induced therapeutic hypothermia with approximately half of volume of iced saline as proposed by current guidelines.1 It enabled good temperature control during maintenancee and rewarming phases.