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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)
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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
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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