Temperature control in critically ill patients with a novel esophageal cooling device: a case series

Abstract

BackgroundMild hypothermia and fever control have been shown to improve neurological outcomes post cardiac arrest. Common methods to induce hypothermia include body surface cooling and intravascular cooling; however, a new approach using an esophageal cooling catheter has recently become available.MethodsWe report the first three cases of temperature control using an esophageal cooling device (ECD). The ECD was placed in a similar fashion to orogastric tubes. Temperature reduction was achieved by connecting the ECD to a commercially available external heat exchange unit (Blanketrol Hyperthermia – Hypothermia System).ResultsThe first patient, a 54 year-old woman (86 kg) was admitted after resuscitation from an out-of-hospital non-shockable cardiac arrest. Shortly after admission, she mounted a fever peaking at 38.3 °C despite administration of cold intravenous saline and application of cooling blankets. ECD utilization resulted in a temperature reduction to 35.7 °C over a period of 4 h. She subsequently recovered and was discharged home at day 23. The second patient, a 59 year-old man (73 kg), was admitted after successful resuscitation from a protracted out-of hospital cardiac arrest. His initial temperature was 35 °C, but slowly increased to 35.8 °C despite applying a cooling blanket and ice packs. The ECD was inserted and a temperature reduction to 34.8 °C was achieved within 3 h. The patient expired on day 3. The third patient, a 47 year-old man (95 kg) presented with a refractory fever secondary to necrotizing pneumonia in the postoperative period after coronary artery bypass grafting. His fever persisted despite empiric antibiotics, antipyretics, cooling blankets, and ice packs. ECD insertion resulted in a decrease in temperature from 39.5 to 36.5 °C in less than 5 h. He eventually made a favorable recovery and was discharged home after 59 days. In all 3 patients, device placement occurred in under 3 min and ease-of-use was reported as excellent by nursing staff and physicians.ConclusionsThe esophageal cooling device was found to be an effective temperature control modality in this small case series of critically ill patients. Preliminary data presented in this report needs to be confirmed in large randomized controlled trials comparing its efficacy and safety to standard temperature control modalities.

Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management

“…Notable Cases Numerous case studies describe the application of esophageal temperature management in practice, including for the treatment of post cardiac arrest ischemia-reperfusion injury, central fever reduction, and maintenance of operative normothermia 20 21 22 23 24 25 26 27 . Though the esophageal temperature management method was initially conceived in the context of cardiac arrest treatment, the following cases highlight its successful translation into other critical care and perioperative domains.…”

“…When appropriately managed, the esophageal temperature management device does not come into contact with the vasculature (as do the intravascular temperature modulation devices) or skin (as do the surface temperature modulation devices), thereby avoiding blood clots, bloodstream infection, and skin degradation. The device can be placed quickly by a variety of healthcare providers, typically in a matter of minutes 21 37 . The insertion technique mimics standard orogastric tube placement, which minimizes workflow disruptions that might delay therapy initiation.…”

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

“…The ability of the ECD to induce cooling, maintain and rewarm accurately critically ill patients has been demonstrated in previous pilot studies [11,14,15,21]. Only two series reported the use of ECD in the field of CA [14,15]. However, ECD was always associated with other cooling methods: basic cooling with ice packs and blankets and large volume of cold fluids.…”

“…Presently, endovascular cooling seems the most effective method regarding TH induction and TT maintenance [8,9]. The ability of the ECD to induce cooling, maintain and rewarm accurately critically ill patients has been demonstrated in previous pilot studies [11,14,15,21]. Only two series reported the use of ECD in the field of CA [14,15].…”

“…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].…”