Intravascular Temperature Management Research Articles

Evaluation of a thermoregulatory intravascular catheter in critically ill burns patients.

Patients with severe burns are at high risk of thermoregulatory failure. Yet, there is a lack of consensus regarding the optimum approach to temperature dysregulation in patients with severe burns. Intravascular temperature management catheters may offer a superior method of temperature control, but robust data is lacking. In this article we describe our experience in using a thermoregulatory catheter for temperature management in a tertiary referral burns centre. We conducted a single-centre, prospective evaluation of the use of a thermoregulatory intravenous catheter system (Thermogard XP®) in critically injured burns patients admitted to our Intensive Care Unit over an 18-month period. 10 patients had a total of 12 catheters inserted. Patient temperatures were maintained between a median low of 36.9°C and median high of 38.4°C whilst in the Intensive Care Unit. If patients were transferred to theatre, the median temperature change was -0.15°C (IQR -0.3, 0) if Total Body Surface Area (TBSA) was ≤50% and -1.45°C (IQR -2.05, -0.975) if >50%. No surgical procedures were terminated due to intra-operative hypothermia. On return from theatre, 72.2% of patients were normothermic with a median temperature of 36.8°C. 30% of patients developed a thrombotic complication. Overall, the device appeared reliable in achieving and maintaining normothermia for critically ill burns patients manifesting temperature dysregulation. It may also be of benefit to patients expected to show temperature fluctuations during operative procedures. Further research is needed to define whether this represents an improvement over current practice and to investigate the thrombus risk associated with such devices.

Cost-Effectiveness Analysis of Intravascular Targeted Temperature Management after Cardiac Arrest in England.

BackgroundTargeted temperature management (TTM) has been shown to improve neurological outcomes and survival in patients resuscitated from cardiac arrest; however, the cost effectiveness of multiple TTM methods is not well studied.ObjectiveThis study aimed to evaluate the cost effectiveness of intravascular temperature management (IVTM) using Thermogard XP compared with surface cooling methods after cardiac arrest in the England from the perspectives of the UK national health service and Personal Social Services.MethodsWe developed a multi-state Markov model that evaluated IVTM (Thermogard XP) compared with surface cooling using two different devices (Blanketrol III and Arctic Sun 5000) over a short-term and lifetime time horizon. Model input parameters were obtained from the literature and local databases. We assumed a hypothetical cohort of 1000 patients who required TTM after cardiac arrest per year in the England. The outcomes were costs (in £, year 2019 values) and quality-adjusted life-years (QALYs), discounted at 3.5% annually. Deterministic and probabilistic sensitivity analyses were undertaken to examine the effect of alternative assumptions and uncertainty in model parameters on the results.ResultsThe cost-effectiveness analysis determined that Thermogard XP resulted in direct cost savings of £2339 and £2925 (per patient) compared with Blanketrol III and Arctic Sun 5000, respectively, and a gain of 0.98 QALYs over the patient lifetime. The probabilistic sensitivity analysis demonstrated that the probability of Thermogard XP being cost saving would be 69.2% and 65.3% versus the Arctic Sun 5000 and Blanketrol III, respectively.ConclusionImplementation of IVTM using Thermogard XP can lead to cost savings and improved patient quality of life versus surface cooling methods.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-022-00333-7.

Influence of the coronavirus disease 2019 (COVID-19) pandemic on the incidence of heat stroke and heat exhaustion in Japan: a nationwide observational study based on the Heatstroke STUDY 2019 (without COVID-19) and 2020 (with COVID-19).

AimTo assess heat stroke and heat exhaustion occurrence and response during the coronavirus disease 2019 pandemic in Japan.MethodsThis retrospective, multicenter, registry‐based study describes and compares the characteristics of patients between the months of July and September in 2019 and 2020. Factors affecting heat stroke and heat exhaustion were statistically analyzed. Cramér’s V was calculated to determine the effect size for group comparisons. We also investigated the prevalence of mask wearing and details of different cooling methods.ResultsNo significant differences were observed between 2019 and 2020. In both years, in‐hospital mortality rates just exceeded 8%. Individuals >65 years old comprised 50% of cases and non‐exertional onset (office work and everyday life) comprised 60%–70%, respectively. The recommendations from the Working Group on Heat Stroke Medicine given during the coronavirus disease pandemic in 2019 had a significant impact on the choice of cooling methods. The percentage of cases, for which intravascular temperature management was performed and cooling blankets were used increased, whereas the percentage of cases in which evaporative plus convective cooling was performed decreased. A total of 49 cases of heat stroke in mask wearing were reported.ConclusionEpidemiological assessments of heat stroke and heat exhaustion did not reveal significant changes between 2019 and 2020. The findings suggest that awareness campaigns regarding heat stroke prevention among the elderly in daily life should be continued in the coronavirus disease 2019 pandemic. In the future, it is also necessary to validate the recommendations of the Working Group on Heatstroke Medicine.

Temporal Changes in Targeted Temperature Management for Out-of-Hospital Cardiac Arrest-Examining the Effect of the Targeted Temperature Management Trial: A Retrospective Cohort Study.

Targeted temperature management (TTM) is recommended after out-of-hospital cardiac arrest (OHCA). However, interpretation of the evidence and translation into clinical practice, to realize benefits to patient outcomes may be inconsistent. This study aims to compare compliance with the recommended targeted temperatures and the use of intravascular temperature management (IVTM), as well as 90-day survival, before and after publication of the TTM trial. A single-center retrospective cohort study was conducted from 2010 to 2017. All comatose patients admitted to the intensive care unit after OHCA, who survived for ≥24 hours, were included. IVTM use was measured and TTM adherence was defined as the percentage time the core temperature was (1) within the guideline-recommended temperature range (initially 32-34°C, later modified to 32-36°C) for the first 24 hours, and (2) ≤37.5°C between 24 and 72 hours following admission. Multiple logistic regression analyses were performed for the use of IVTM and survival at 90 days. Of the 302 patients identified, 136 (45%) were pre-TTM, and 166 (55%) post-TTM. Baseline characteristics were similar between the groups. IVTM use decreased significantly (77.9% vs. 51.8%, p < 0.001) after the publication of the TTM trial. Adherence to the 32-34°C and 32-36°C targets was higher pre-TTM as compared with the post-TTM cohort (33.3% [0-66.7%] vs. 0% [0-16.7%], p < 0.001 and 83.3% [50.0-100%] vs. 36.7% [16.7-66.7%], p < 0.001, respectively). Time with temperature ≥37.5°C in the first 24 hours was higher post-TTM (p = < 0.001) but not between 24 and 72 hours. Ninety-day survival was 54.4% in the pre-TTM cohort and 44.0% post-TTM, (odds ratio 1.52 [0.96-2.40], p = 0.083). Adherence with recommended TTM decreased significantly following publication of the TTM trial and this was explained by a significant decrease in IVTM use. However, this concerning trend did not result in a statistically significant difference in survival.

Precision and Safety of an Intravascular Temperature Management System for Postcardiac Arrest Syndrome Patients: A Multicenter Clinical Trial (COOL-ARREST JP).

Rapid induction and maintaining a target temperature of 32.0–36.0°C within a narrow range for <24 hours are essential, but those are very hard to perform in postcardiac arrest syndrome (PCAS) patients. We investigated the usability of an intravascular temperature management (IVTM) system with neurolept-anesthesia (NLA; droperidol and fentanyl). Single-arm, prospective multicenter trial was carried out in the seven university and the three affiliated hospitals. In the 24 comatose PCAS patients, the target temperature (33.0°C) was rapidly induced and maintained for 24 hours using an IVTM system with NLA. The rewarming speed was 0.1°C/h until 36.5°C and was maintained for 24 hours. The primary end point was the ability to achieve ≤34.0°C for <3 hours after starting cooling, and the secondary end points were the cooling rate, deviation from the target temperature, and adverse events. Cerebral Performance Category (CPC) score at 14 days was also evaluated. Statistical analyses were performed by SPSS software, using the intention-to-treat data sets. The target temperature of ≤34.0°C was reached by 45 minutes (35–73 minutes) and was within 3 hours in all patients. The cooling rate from 36.4°C to 33.0°C was 2.7°C/h (2.4–3.6°C/h). The temperature of 33.1°C (33.1–33.1°C) and 36.7°C (36.6–36.9°C) for 24 hours each was held during the maintenance and the after rewarming phases, respectively. Temperature deviations >0.2°C from 33.0°C in the maintenance phase occurred once each in two patients. The favorable neurological outcomes (CPC1, 2) were relatively good (50%). Five patients experienced serious adverse events; none was device related. We rapidly achieved therapeutic hypothermia within a narrow temperature range without major complications using the IVTM system with NLA in PCAS patients.

4034Distance from hospital as an early marker of outcomes in out of hospital cardiac arrest acute myocardial infarction survivors treated with endovascular mild therapeutic hypothermia

Abstract Background The prediction of outcome in comatose patients after out of hospital cardiac arrest (OHCA) has major ethical and socioeconomic implications. At present, there is a lack of data comparing the predictive value from cardiac arrest localization to hospital distance in OHCA survivors treated with endovascular therapeutic hypothermia. Methods 86 patients (64±14 years, 69 men) were evaluated after OHCA due to ventricular fibrillation (VF) during an acute myocardial infarction (MI). All patients (NSTEMI 28%, STEMI 72%) were indicated for urgent coronary angiography, echocardiography for left ventricular ejection fraction (LVEF) estimation using Simpson biplane formula and treated with mild therapeutic hypothermia (MTH) using intravascular temperature management to maintain target temperature (33 °C) for 24 hours. The Cerebral Performance Categories scale (CPC) was used as the outcome measure and was assessed 3 months post admission; a CPC of 3–5 was regarded as a poor outcome (n=45), and a CPC of 1–2 (n=41) as a good outcome. Results Distance to hospital was significantly higher (p=0.0473) in patients with poor outcomes (CPC 3–5) after OHCA (37.5±4.5 km) compared with CPC 1–2 patients (27.1±4.4 km). No significant differences in return of spontaneous circulation time (21; 10.5–47.5 95th percentile vs. 23; 10.0–50.0, p=0.738), lactate (7.8; 4.5–12.4 vs. 8.4; 5.4–13.5, p=0.54), LVEF (40; 22–50 vs. 40; 21–62%, p=0.208), peak cardiac troponin T (1.5; 0.08–10.00 vs. 0.64; 0.04–5.28 μg/L, p=0.078), NSE (29.2; 15.7–54.9 vs. 25.8; 13.6–52.3 μg/L, p=0.26) and S100-B (0.17; 0.09–1.69 vs. 0.19; 0.04–1.14 μg/L, p=0.734) were found in CPC 3–5 and CPC 1–2 groups comparison. Using an optimal cut-off value ≥33 km calculated from the receiver operating characteristic curve (area under curve = 0.62; p=0.004), the sensitivity of predicting survival with poor neurological outcome was 61% and the specificity was 62%. Conclusions In patients after OHCA for VF during MI, distance from cardiac arrest localization to hospital gives reliable and on return of spontaneous circulation time independent prognostic information concerning outcome after cardiopulmonary resuscitation. Acknowledgement/Funding Grant support FNOL RIV 87-85

Effect of Intravascular Cooling on Microvascular Obstruction (MVO) in Conscious Patients with ST-Elevation Myocardial Infarction Undergoing Primary PCI: Results from the COOL AMI EU Pilot Study.

COOL AMI EU pilot was a multi-center, randomized controlled trial to assess feasibility and safety of rapid intravascular therapeutic hypothermia (TH) in conscious patients with anterior ST-elevation myocardial infarction (STEMI) undergoing primary PCI (PPCI). We report the effect of hypothermia upon microvascular obstruction (MVO). Conscious patients with anterior STEMI and symptom duration <6 h were recruited and randomized to PPCI + TH or PPCI alone. TH was induced using the ZOLL® Proteus™ intravascular temperature management system and rapid infusion of 1 L of cold normal saline, with a target temperature of 32 °C. MVO was measured by cardiac magnetic resonance (CMR) at 4 to 6 days post-MI. MVO larger than 3.9% of LV was considered as extensive MVO. 50 patients were randomized; mean age was 58 years, and 86% were men. At reperfusion, mean intravascular temperature for the TH group was 33.6 ± 1 °C. The presence of MVO was high and not different in both groups (74% vs. 77%, p = 0.79). The proportion of patients with extensive MVO was 11% in the TH group and 23% in the control group (OR 0.4 95%CI 0.07-2.35, p = 0.30). Patients with extensive MVO showed reduced EF at 4-6 days (34% versus 43%, p = 0.01). The percentage of patients with EF <35% at 30 days was 6% in the TH group versus 24% in the control group (p = 0.19). In the COOL-AMI Pilot Trial, the presence of MVO in both test groups was high and extensive MVO was related with reduced LVEF. The efficacy of therapeutic hypothermia (TH) in MVO reduction should be tested in a pivotal trial.

Feasibility and Safety of Intravascular Temperature Management for Severe Heat Stroke: A Prospective Multicenter Pilot Study.

Heat stroke is a life-threatening condition with high mortality and morbidity. Although several cooling methods have been reported, the feasibility and safety of treating heat stroke using intravascular temperature management are unclear. This study evaluated the efficacies of conventional treatment with or without intravascular temperature management for severe heat stroke. Prospective multicenter study. Critical care and emergency medical centers at 10 tertiary hospitals. Patients with severe heat stroke hospitalized during two summers. Conventional cooling with or without intravascular temperature management. Cooling efficacy, Sequential Organ Failure Assessment score, occurrence rate of serious adverse events, and prognosis based on the modified Rankin Scale and Cerebral Performance Category. Patient outcomes were compared between five centers that were prospectively assigned to perform conventional cooling (control group: eight patients) and five centers that were assigned to perform conventional cooling plus intravascular temperature management (intravascular temperature management group: 13 patients), based on equipment availability. Despite their higher initial temperatures, all patients in the intravascular temperature management group reached the target temperature of 37°C within 24 hours, although only 50% of the patients in the control group reached 37°C (p < 0.01). The intravascular temperature management group also had a significant decrease in the Sequential Organ Failure Assessment score during the first 24 hours after admission (4.0 vs 1.5; p = 0.04). Furthermore, the intravascular temperature management group experienced fewer serious adverse events during their hospitalization, compared with the control group. The percentages of favorable outcomes at discharge and 30 days after admission were not statistically significant. The combination of intravascular temperature management and conventional cooling was safe and feasible for treating severe heat stroke. The results indicate that better temperature management may help prevent organ failure. A large randomized controlled trial is needed to validate our findings.

COOL-ARREST: Results from a Pilot Multicenter, Prospective, Single-Arm Observational Trial to Assess Intravascular Temperature Management in the Treatment of Cardiac Arrest.

Targeted temperature management (TTM) is recommended postcardiac arrest. The cooling method with the highest safety and efficacy is unknown. The COOL-ARREST pilot trial aimed to evaluate the safety and efficacy of the most contemporary ZOLL Thermogard XP Intravascular Temperature Management (IVTM) system for providing mild TTM postcardiac arrest. This multicenter, prospective, single-arm, observational pilot trial enrolled patients at eight U.S. hospitals between July 28, 2014, and July 24, 2015. Adult (≥18 years old), out-of-hospital cardiac arrest subjects of presumed cardiac etiology who achieved return of spontaneous circulation (ROSC) were considered for inclusion. Patients were excluded if (1) awake or consistently following commands after ROSC, (2) significant prearrest neurological dysfunction, (3) terminal illness or advanced directives precluding aggressive care, and (4) severe hemodynamic instability or shock. Patient temperature was maintained at 33.0°C ± 0.3°C for a total of 24 hours followed by controlled rewarming (0.1-0.2°C/h). Logistic regressions were used to assess association of good functional outcome (modified Rankin Scale ≤3) measured at the time of hospital discharge with shockable rhythm (yes/no), age, gender, race/ethnicity, lay-rescuer cardiopulmonary resuscitation, time to basic life support (minutes), time to ROSC (minutes), lactate (mg/dL), and pH on admission. The ZOLL IVTM system was effective at inducing TTM (median time to target temperature from initiation, 89 minutes [interquartile range 42-155]). Adverse events most often included electrolyte abnormalities and dysrhythmias. Of patients surviving to hospital discharge, 16/20 patients had a good functional outcome. A total of 18 patients survived through 90-day follow-up, at which time 94% (17/18) of patients had good functional outcome. The COOL-ARREST pilot trial demonstrates high safety and efficacy of the ZOLL Thermogard XP IVTM system in the application of mild TTM postcardiac arrest. This observational trial also revealed noteworthy variability in the management of postcardiac arrest patients, particularly with the use of early withdrawal of life-sustaining therapy.

Intravascular temperature management of a patient undergoing pancreatic head resection

SummaryPeri‐operative hypothermia has a high incidence during major abdominal surgery and is associated with serious complications. Intravascular temperature management (IVTM) is a well‐established technique in critical care medicine. There is currently limited experience in its use to maintain peri‐operative normothermia, however recent improvements in technical specifications of IVTM catheters suggest a promising approach for intra‐operative use.In this report, we describe a case where intra‐operative IVTM was used in addition to conventional non‐invasive temperature management (NITM) in order to prevent hypothermia. Due to this management, the patient undergoing pancreatic head resection did not develop hypothermia at any time of the procedure. This highlights that intra‐operative use of IVTM could be considered as an additional component of peri‐operative temperature management during abdominal surgery.

COOL AMI EU pilot trial: a multicentre, prospective, randomised controlled trial to assess cooling as an adjunctive therapy to percutaneous intervention in patients with acute myocardial infarction.

We aimed to investigate the rapid induction of therapeutic hypothermia using the ZOLL Proteus Intravascular Temperature Management System in patients with anterior ST-elevation myocardial infarction (STEMI) without cardiac arrest. A total of 50 patients were randomised; 22 patients (88%; 95% confidence interval [CI]: 69-97%) in the hypothermia group and 23 patients (92%; 95% CI: 74-99) in the control group completed cardiac magnetic resonance imaging at four to six days and 30-day follow-up. Intravascular temperature at coronary guidewire crossing after 20.5 minutes of endovascular cooling decreased to 33.6°C (range 31.9-35.5°C). There was a 17-minute (95% CI: 4.6-29.8 min) cooling-related delay to reperfusion. In "per protocol" analysis, median infarct size/left ventricular mass was 16.7% in the hypothermia group versus 23.8% in the control group (absolute reduction 7.1%, relative reduction 30%; p=0.31) and median left ventricular ejection fraction (LVEF) was 42% in the hypothermia group and 40% in the control group (absolute reduction 2.4%, relative reduction 6%; p=0.36). Except for self-terminating paroxysmal atrial fibrillation (32% versus 8%; p=0.074), there was no excess of adverse events in the hypothermia group. We rapidly and safely cooled patients with anterior STEMI to 33.6°C at the time of coronary guidewire crossing. This is ≥1.1°C lower than in previous cooling studies. Except for self-terminating atrial fibrillation, there was no excess of adverse events and no clinically important cooling-related delay to reperfusion. A statistically non-significant numerical 7.1% absolute and 30% relative reduction in infarct size warrants a pivotal trial powered for efficacy.

26 Feasibility of therapeutic hypothermia in stemi: single UK heart attack centre experience

Background Primary PCI is the gold standard treatment for acute STEMI, but reperfusion injury limits its beneficial effect on infarct size (IS). In experimental studies, therapeutic hypothermia (HT) consistently reduces IS caused by reperfusion injury, but translation into clinical practice remains a challenge. The purpose of our study (part of COOL AMI EU study) was to assess the feasibility of integrating pre-reperfusion HT using an intravascular temperature management system (Thermogard XP, ZOLL, USA) into routine clinical practice without a significant delay in door-to-balloon (DTB) time. Methods Patients with STEMI presenting within 6 h of symptoms onset and planned for PPCI were prospectively enrolled. TH was implemented by intravenous infusion (IV) of cold saline and a heat-exchange balloon catheter inserted via the right femoral vein. Oral buspirone and IV pethidine were used to control shivering. HT was continued for a total time of 3 h, followed by passive rewarming. Results 18 patients were successfully recruited. The average age was 60.3 years and 94.4% were male. The DTB time was 40.6 min. There was an increase of 3.6 min compared with the mean DTB time of 37 min for patients who underwent PPCI and did not received HT. Mean temperature at reperfusion was 34.4 ° C. There were no adverse events related to the use of the heat-exchange catheter or the implementation of hypothermia. Conclusion Hypothermia is feasible and safe in STEMI patients without significant delay in door-to-balloon time.

Evaluation of advanced cooling therapy’s esophageal cooling device for core temperature control

ABSTRACTManaging core temperature is critical to patient outcomes in a wide range of clinical scenarios. Previous devices designed to perform temperature management required a trade-off between invasiveness and temperature modulation efficiency. The Esophageal Cooling Device, made by Advanced Cooling Therapy (Chicago, IL), was developed to optimize warming and cooling efficiency through an easy and low risk procedure that leverages heat transfer through convection and conduction. Clinical data from cardiac arrest, fever, and critical burn patients indicate that the Esophageal Cooling Device performs very well both in terms of temperature modulation (cooling rates of approximately 1.3°C/hour, warming of up to 0.5°C/hour) and maintaining temperature stability (variation around goal temperature ± 0.3°C). Physicians have reported that device performance is comparable to the performance of intravascular temperature management techniques and superior to the performance of surface devices, while avoiding the downsides associated with both.

Hypothermia in burns intensive care: use of the intravenous temperature management system Thermogard XP®

The care of the patient with major burns in the ICU is a complex and challenging task. They differ from the other critical care patient groups in several ways. One of the major challenges faced is confronting their hypermetabolic state and temperature management [1]. It is widely known that major burn injury is associated with the most profound of hypermetabolic responses to a pathological state. Hyperthermia that is non-infectious is a feature of the systemic inflammatory response to this. In burns intensive care, the disproportionate increase in metabolic rate to small rises in core temperature can have significant impact on resuscitation and prognosis. The pathophysiology of the hyperthermic response in major burn injury is poorly understood. It could be secondary to an infective etiology or a metabolic response to the systemic inflammation. Irrespective of the reason, sustained hyperthermia above 40°C can culminate in cellular injury and death [2]. The hypermetabolic response starts within the first 5 days of the major burn and can last for a year after the injury. Because of the ongoing systemic inflammatory stimulation, patients with major burns often have pyrexia and their thermoregulatory system reset at a higher baseline temperature around 38.5°C [3]. While therapeutic cooling is widely used in neuro intensive care in the management of hyperthermic brain-injured patients and in patients after out-of-hospital cardiac arrests, there is very scarce literature available on the management of hyperthermia in burns intensive care. We, in this article, would like to share our experience of using the intravascular temperature management system (IVTM) Thermoguard XP® in our unit to manage refractory hyperthermia in patients with major burns. We report the responses of two major burns patients to core intravascular thermoregulation during periods of severe hyperthermia (>40°C). Case 1 A 24-year-old male had sustained 80% mixed depth, total body surface area (TBSA) flame burns following a road traffic accident. He had no significant past medical history. Initial resuscitation including endotracheal intubation and fluid resuscitation was instituted in the nearby district general hospital and was transferred over to our burns ICU without much delay. On admission to the ICU, detailed assessment of the burn injuries revealed second-degree and third-degree burns involving the trunk, abdomen, back, upper and lower extremities. Initial temperature recorded was 34°C. He responded to external warming, which included nursing in a warm environment, use of warm air blanket and warm fluids. The patient underwent extensive escharatomies on the day of admission as a part of his initial resuscitation. He developed multiorgan failure requiring high inotropic support, renal replacement therapy and high FiO2. He developed hyperpyrexia (temperature >42°C) on day 11 post burn. Relevant microbiology investigations had demonstrated no obvious focus of ongoing infection. The hyperpyrexia was resistant to conventional active cooling (bladder/gastric lavage, hemofiltration, external cooling with cooling blanket). The hyperpyrexia was associated with marked tachycardia (heart rate >150 beats/minute) with increasing oxygen demands and hypotension with escalating inotropic support. Forced core thermoregulation was commenced due to instability attributed to high core temperature. The Thermogard XP® was inserted in the femoral vein, the target temperature was set at 37°C. Within 2 hours of initiating the IVTM, the core body temperature dropped by 3°c down to 39°C. It took a further 3 hours to stabilise at the target temperature of 37°C. The IVTM system was used for a period of 6 days. The objective measurements of pulse rate, blood pressure, respiratory rate and urine output were seen to improve in the presence of a normothermic state (Figure ​(Figure1).1). After a protracted and convoluted stay in the ICU, the patient was discharged to a ward after 38 days. Open in a separate window Figure 1 Response in vital parameters in the first 20 hours after initiating IVTM: case 1.

Audit of active cooling methods in induced therapeutic hypothermia

The induction of therapeutic hypothermia following cardiac arrest is now an International Liaison Committee on Resuscitation (ILCOR) level 1 recommendation, and level A recommendation from the Australian Resuscitation Council (ARC). To facilitate therapeutic hypothermia we introduced the use of an intravascular temperature management catheter (IVTMC) and audited its use in comparison to the more conventional methods of surface cooling and cold intravenous fluids (CM).

Intravascular cooling for rapid induction of moderate hypothermia in severely head-injured patients: results of a multicenter study (IntraCool)

To evaluate the feasibility, safety and effectiveness of a new method of intravascular temperature management for inducing moderate hypothermia (MHT). Prospective, international-multicenter clinical trial conducted in four university hospitals. In a 2-year period 24 patients with severe head injury and refractory high ICP were treated with MHT (32.5 degrees C) by intravascular methods. Seventeen were males and seven females, with a median age of 25 years (range 15-60). The median Glasgow Coma Scale upon admission was 7 (range 3-13) and the median Injury Severity Score was 22 (range 13-43). A total of 75% of patients presented a diffuse lesion in the pre-enrollment computed tomography. Median time from injury until reaching refractory high ICP was 71.5 h after injury (minimum 14 h, maximum 251 h). Twelve patients (50%) reached this situation within the first 72 h after injury. MHT was attained in a median time of 3 h. Pre-enrollment median ICP was 23.8 mmHg and was reduced to 16.8 mmHg upon reaching target temperature. At 6 months after injury, nine patients had died (37.5%), six were severely disabled (25%), two moderately disabled (8.3%) and seven had a good recovery (29.2%). Of the nine patients who died, in four the cause was rebound ICP during rewarming, one death was attributed to accidental potassium overload, two to septic shock, one to cardiac arrest of unknown origin and the ninth to a pulmonary embolism. Intravascular methods to induce MHT combined with precooling with cold saline at 4 degrees C appear to be feasible and effective in reducing ICP in patients with high ICP refractory to first-line therapeutic measures.