surface_cooling_vs

8/7/2019 Surface_Cooling_Vs

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Surface Cooling Vs.Intravascular cooling


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Surface Cooling

Cheaper MethodsFansIceAmbientWater

OtherBlanket Devices

Anyone Can do it


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Limitations of Surface Cooling

Limits access to patient (surface cooling)

Nurse intensive / wet surface poses risk(ice/lavage/cooling blanket)

Difficulty during target temp maintenance

overshoot Uncontrolled rewarming rebound ICP and

hyperthermia

Increased shivering (surface cooling) Rolling patient to place additional cooling on the

back poses risk (cooling pad/blanket)


4/10

It is important to switch from externalcooling as soon as feasible

Treatment Modalities

Cooling using external ice packsUniversity of Chicago 2003-2004 Study


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Nurses have a

63% chance of overcoolingtheir patients when using

surface cooling methods

37% 63%

Controlled Surface Cooling Overcooling

Of that 63%.....

35%

44%

21%

Rebound Fever

Temperature below 30C

Temperature below 31C

Resulting in: Atrial or ventricular arrhythmias

Coagulopathy

Increased risk of infection

Interference with resuscitation, i.e electricalshocks and anti-arrhythmic therapies

References

Raina M. Merchant, MD; Benjamin S. Abella, MD MPhil' Mary Ann Peberdy, MD; Jasmeet Soar, MD; marcus E. H. Ong, MBBS, MPH; Gregory A. Schmidt, MD; Lance B. Becker, MD; Terry L.Vanden Hoek, MD: Therapeudic Hypothermia After Cardiac Arrest: Unintentional Overcooling is Common Using Ice Packs and Conventional Cooling Blankets. Crit Care Med 2006 Vol. 34, No. 12


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Death Rate:

Overcooling vs. Not Overcooling

70%

30%

Survival

Death 58%

42%

Survival

Death

Overcooling Not Overcooling

References

Raina M. Merchant, MD; Benjamin S. Abella, MD MPhil' Mary Ann Peberdy, MD; Jasmeet Soar, MD; marcus E. H. Ong, MBBS, MPH; Gregory A. Schmidt, MD; Lance B. Becker,MD; Terry L. Vanden Hoek, MD: Therapeudic Hypothermia After Cardiac Arrest: Unintentional Overcooling is Common Using Ice Packs and Conventional Cooling Blankets. CritCare Med 2006 Vol. 34, No. 12


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29%

41%

55%

0%

20%

40%

60%

Control Surface Cooling Intravascular Cooling

Better Temperature Management

= Better MedicineHACA Trial Alsius Icy Trial

Time to Target Temperature

Mortality

SixMonthResults

N = 86N = 275

Holzwe M, Sterz F, et al Stroke. July 2006


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Advantages of Intravascular Cooling

Easy to initiate therapy

Does not interfere with patient access/care activities

No thermal injury worries Reduced shivering compared with surface cooling

Central venous access

Easy, quick disconnect when patient moves withinhospital

Control and accuracy of temperature maintenance is

superior Controlled rate of rewarming

Manages rebound hyperthermia post-hypothermia

procedure up to 4 or 7 days


9/10

Clinical Applications Where ALSIUS Intravascular

Temperature Management Has Been UsedFor Cooling

Fever control in Neuro/Surgical ICU

Therapeutic hypothermia after cardiac arrest

ICP (intracranial pressure) management

Therapeutic hypothermia for brain trauma and stroke

Acute liver failure

Adjunct with interventional procedure

Malignant hyperthermia

Heat stroke

Spinal cord injury

Spinal surgery

Adjunct with hemicraniectomy


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Clinical Applications Where ALSIUS Intravascular

Temperature Management Has Been UsedFor Warming

Trauma victims Accidental hypothermia

Burn surgery and intensive care

Cardiac surgery

OPCAB (off-pump coronary artery bypass)

Post-bypass pump (prevention of after-drop)

Thoracic aneurysm surgery

Maintain viable donor organs for transplantation

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