Abstract P191: Rapid Surface Cooling in Unconscious Post Resuscitation Patients Following Cardiac Arrest: Safety, Efficacy, and Outcomes
Therapeutic Hypothermia has become a standard of care for unconscious post resuscitation patients. Rapid cooling is considered essential, but most techniques currently in use are slow, often taking a number of hours. We report the preliminary results of an observational study of a rapid whole body cooling device (Thermosuit® System, Life Recovery Systems) to assess rate of cooling and product feasibility. The Thermosuit device cools the patient by circulating a thin film of ice-cold water in direct contact with most of the skin surface. The patient is removed from the device upon reaching the target temperature. 23 patients with post resuscitative coma were enrolled from three centers using a standardized protocol. Patients were cooled to 32–34 degrees and maintained at that temperature for 12 to 23 hours before re-warming over 12 hours. The primary outcome measure was cooling time, but data collected included arrest time, drug administration, operator interaction with the device, adverse events, and neurological outcome using the NIH stroke scale, Mini Mental State Exam (MMSE), Modified Rankin Score (MRS) and Cerebral Performance Category (CPC). 22 patients were available for follow-up. Cooling was rapid with an average time to reach 34 °C of 40.8 (±17.1) minutes. This was an average drop of 2.2(±0.85) °C . In a subset of 7 subjects who received propofol, cooling times decreased to 27.4 (±8.4) min (p<.05). Only 5 of the 23 subjects required additional cooling during the 12 hour period. 15 patients survived to discharge at one month. For the surviving study patients, the median CPC was 2.0 (average 1.83±0.83), MMSE was 28 and MRS was 1.5. These scores describe a very good neurological outcome. There were no adverse events attributable to the device.
Conclusion: The Thermosuit System was able to cool patients to target temperature extremely quickly, and resulted in a much higher than expected survival rate and good neurological outcome, with no adverse events attributable to the device.