Novel wearable cooling device for early initiation of targeted temperature management in the Emergency Department

Leong Gen Yap, Nur Shahidah, Sohil Pothiawala, Kenneth Boon Kiat Tan, Aaron Sung Lung Wong, Duu Wen Sewa, Eric Tien Siang Lim, Chee Tang Chin, Weiting Huang, Marcus Eng Hock Ong


Background: Targeted temperature management (TTM) is an important component of post-cardiac arrest care. Studies have suggested that cooling is associated with better outcomes. The aim of this study was to evaluate the cooling efficacy of a protocol including a novel cooling device in the Emergency Department.
Methods: This was a single-center, pre-post cohort study of post-cardiac arrest patients with return of spontaneous circulation (ROSC), for whom TTM was initiated at a tertiary hospital between April 2010 and December 2017. A surface cooling device which uses a graphite cooling material in an insulating suit was introduced in July 2015. The target temperature was 34.0 °C with TTM continued in the ICUs. The primary outcome was time from ROSC to target temperature (TT).
Results: Of 124 patients included, 40 were in the intervention period and 84 in the control period. Time from ROSC to TT was significantly lower in the intervention period at 119 [interquartile range (IQR), 65–250] minutes versus 482 (IQR, 356–596) minutes (P<0.001). The intervention period also had a faster cooling rate [initiation of TTM to TT of 73 (IQR, 40–150) versus 142 (IQR, 75–262) minutes, P=0.014]. There was no statistical difference in survival to discharge. There were no reported serious adverse events associated with the device.
Conclusions: Use of a novel cooling device in the ED resulted in a shorter time to target temperature. As it is reusable and does not require a power source, it has potential to be an affordable solution for pre- hospital and transport cooling.