Elsevier

Resuscitation

Volume 121, December 2017, Pages 54-61
Resuscitation

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

https://doi.org/10.1016/j.resuscitation.2017.09.021Get rights and content
Under a Creative Commons license
open access

Abstract

Background

Targeted temperature management (TTM) between 32 and 36 °C is recommended after out-of-hospital cardiac arrest (OHCA). We aimed to assess the feasibility and safety of the “Esophageal Cooling Device” (ECD) in performing TTM.

Patients and methods

This single-centre, prospective, interventional study included 17 comatose OHCA patients. Main exclusion criteria were: delay between OHCA and return of spontaneous circulation (ROSC) >60 min, delay between sustained ROSC and inclusion >360 min, known oesophageal disease. A TTM between 32 and 34 °C was performed using the ECD (Advanced Cooling Therapy, USA) connected to a heat exchanger console (Meditherm III®, Gaymar, France), without cold fluids’ use. Primary endpoint was feasibility of inducing, maintaining TTM, and rewarming using the ECD alone. Secondary endpoints were adverse events, focusing on potential digestive damages. Results were expressed as median (interquartiles 25–75).

Results

Cooling rate to reach the Target Temperature (33 °C-TT) was 0.26 °C/h [0.19-0.36]. All patients reached the 32–34 °C range with a time spent within the range of 26 h [21–28] (3 patients did not reach 33 °C). Temperature deviation outside the TT during TTM-maintenance was 0.10 °C [0.03–0.20]. Time with deviation >1 °C was 0 h. Rewarming rate was 0.20 °C/h [0.18–0.22]. Among the 16 gastrointestinal endoscopy procedures performed, 10 (62.5%) were normal. Minor oeso-gastric injuries (37.5% and 19%, respectively) were similar to usual orogastric tube injuries. One patient experienced severe oesophagitis mimicking peptic lesions, not cooling-related. No patient among the 9 alive at 3-month follow-up had gastrointestinal complains.

Conclusion

ECD seems an interesting, safe, accurate, semi-invasive cooling method in OHCA patients treated with 33 °C-TTM, particularly during the maintenance phase.

Keywords

Cardiac arrest
Oesophageal cooling
Safety
Feasibility
Gastrointestinal endoscopy
Therapeutic hypothermia

Cited by (0)

☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at DOI: 10.1016/j.resuscitation.2017.09.021.