Original Article
Novel wearable cooling device for early initiation of targeted temperature management in the Emergency Department
Abstract
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.
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.
