emcools studies

 

Cardiac Arrest

 

Pre-hospital application

Pre-hospital therapeutic hypothermia after resuscitation – 2 years’ experience in Salzburg

Franz, A. et al. (2011)

Summary

Since 2005, mild therapeutic hypothermia has been part of the guidelines of the European resuscitation council for therapy in the post-resuscitation phase. In August 2008, emergency medical services in the city of Salzburg introduced this therapy as standard operating procedure after primary successful resuscitation. In a study, data from 52 patients was gathered (in retrospect) and the neurological outcome of surviving patients with and without pre-clinical cooling after resuscitation was evaluated. An inconspicuous neurological status was found with 62.5% of patients that were cooled and 27.3% of the non-cooled. Even though a small sample was taken, the results suggest that a pre-clinical application of the hypothermia with resuscitated patients is useful.

Out-of-hospital surface cooling to induce mild hypothermia in human cardiac arrest – a feasibility trial
Uray, T. et al. (2008)

Conclusions

Non-invasive surface cooling with emcools pad immediately after resuscitation from cardiac arrest, in the out-of-hospital setting, showed to be feasible and safe. If early cooling, as compared to delayed cooling in the hospital, will improve neurological outcome, needs to be determined in a prospective randomized trial.

 

In-hospital application

Surface cooling for rapid induction of mild hypothermia after cardiac arrest – design determines efficacy
Uray, T. et al. (2010)

Conclusions

With adequate design and storage temperature, noninvasive surface cooling with this cooling pad is efficient for rapid in-hospital induction of mild hypothermia in patients resuscitated from cardiac arrest. A prospective, randomized clinical trial is needed to determine whether early and fast induction of mild hypothermia improves neurologic outcome.

 

Application in healthy volunteers

Surface cooling for induction of mild hypothermia in conscious healthy volunteers
Testori, C. et al. (2010)

Conclusions

Non-invasive surface cooling is feasible and well tolerated in conscious healthy volunteers and might be an easy and effective cooling methods for awake patients with stroke or myocardial infarction.

 

Animal Studies

Rapid non-invasive external cooling to induce mild therapeutic hypothermia In human-sized swine
Bayegan, K. et al. (2008)

Summary

Aim of the study: Mild therapeutic hypothermia is a promising new therapy for patients
resuscitated from cardiac arrest. Early and fast induction of hypothermia seems to be crucial
for best results. The aim of the study was to investigate the feasibility and safety of a new
surface cooling method using cold metal plates.

Comparison of surface cooling and invasive cooling for rapid induction of mild therapeutic Hypothermia in pigs – effectiveness of two different devices
Haugk, M. et al. (2010)

Conclusion

Non-invasive surface cooling is a highly effective method for quickly inducing mild therapeutic hypothermia in a pig model. It performed with a three times higher cooling rate than an established invasive cooling method without overshoot.

Tracheal temperature for monitoring body temperature during mild hypothermia in pigs
Krizanac, D. et al. (2010)

Conclusion

During steady state and at a cooling rate that does not exceed 4.5 ◦C/h, tracheal temperature measurement is feasible, shows a small bias in regards to faster cooling rates and accurately approximates pulmonary artery temperature with minimal underestimation. During very high cooling rates it shows a bigger hysteresis and a higher variability. Tracheal temperature is an accurate surrogate for body temperature during fast and slow cooling to mild hypothermia in pigs regardless of the location of the temperature probe on the tube.

The importance of surface area for the cooling efficacy of mild therapeutic hypothermia
Weihs, W. et al. (2010)

Conclusions

The cooling pads were effective and safe for rapid induction of mild hypothermia in adult, human-sized pigs, depending on the percentage of body surface area covered. For out-of-hospital use in ambulances, coverage of only the neck, chest, and abdomen might achieve satisfactory cooling rates. The neck region seems to be important for therapeutic hypothermia, especially in the brain.

Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation

Arrich, J. et al. (2016)

Key results

When we compared people whose bodies were cooled to 32°C to 34°C after resuscitation versus those whose bodies were not cooled at all, we found that 63% of those receiving cooling would suffer no, or only minor, brain damage, while only 33% of those not cooled would suffer no, or only minor, brain damage. Cooling had an important effect on simple survival, with or without brain damage:
57% would survive if their bodies were cooled compared with 42% if their bodies were not cooled at all. No serious side effects occurred, but cooling the body was associated with increased risk of pneumonia (49% vs 42% of those studied) and increased risk of low concentrations of potassium in the blood (18% vs 13%).

 

Hyperthermia

The use of emergency medical cooling system pads in the treatment of malignant hyperthermia
Dhaese, H. et al. (2010)

The use of emergency medical cooling system pads in the treatment of malignant hyperthermia

 

Myocardial infarction

Strategic target temperature management in myocardial infarction – a feasibility trial

Testori, C. et al. (2013)

Conclusions

The temperature care bundle used in this trial is feasible and safe for induction of prereperfusion hypothermia in patients with ongoing STE-ACS. Further studies are  eeded to evaluate if changes in the cooling procedure enable to get more patients within therapeutic ranges of hypothermia and if this approach improves outcomes in patients with ongoing STE-ACS.

Surface cooling for induction of mild hypothermia in conscious healthy volunteers – a feasibility trial
Testori, C. et al. (2011)

Conclusions

Non-invasive surface cooling is feasible and well tolerated in conscious healthy volunteers, and might be an easy and effective cooling methods for awake patients with stroke or myocardial  infarction.

Therapeutic hypothermia for the treatment of acute myocardial infarction – combined analysis of the RAPID MI-ICE and the CHILL-MI trials

Erlinge, D. et al. (2015)

Conclusions

The pooled analysis of RAPID MI-ICE and CHILL-MI indicates that hypothermia induced by a combination of cold saline infusion and endovascular cooling in STEMI patients might reduce IS and the incidence of heart failure. This potential effect seems to be most pronounced in patients with large anterior infarctions who present early after symptom onset. These findings warrant confirmation by a larger scale prospective trial of endovascular cooling in the routine care of AMI focusing on the potential target population with large anterior myocardial infarction.

 

Stroke

Performance of the emcools surface cooling system for acute fever control in neurocritical care patients

Mayer, S. et al. (2016)

Conclusions

Preliminary results show the emcools system is an effective, safe, and well-tolerated method to control temperature elevations in neurologically critically ill patients. The emcools system is a feasible method of temperature control in the critical care setting. Level of consciousness has a large impact on the cooling effect of this system.

 

Sepsis

Teilnahme an der CASS Studie

Cooling and surviving septic shock

 

Case studies are available upon request.

 

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Guidelines

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Guidelines Normothermia