Markota Andrej, Fluher Jure, Kit Barbara, Balažič Petra, Sinkovič Andreja
Medical Intensive Care Unit, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia.
Medical Intensive Care Unit, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
Am J Emerg Med. 2016 Apr;34(4):741-5. doi: 10.1016/j.ajem.2016.01.028. Epub 2016 Jan 28.
Temperature management is a recommended part of post-resuscitation care of comatose survivors of cardiac arrest. A number of methods exist for temperature management, all of which have limitations. We aimed to evaluate the performance and ease of use of a new esophageal heat transfer device (EHTD; Advanced Cooling Therapy, Chicago, IL, USA) for temperature management of adult survivors of cardiac arrest.
We performed a prospective study from March to June 2015. Our standard protocol uses servo-controlled water blankets supplemented with ice-cold saline in order to attain goal temperature (32°C-34°C) within 1 hour. We substituted the EHTD for our usual water blankets, then recorded temperature over time and adverse effects.
A total of 14 patients were treated, with mean age 65.1±13.7 years, and median weight 75.5 (70; 83) kg. Initial temperature was 35.3±1.2°C. Mean cooling rate during the induction phase was 1.12±0.62°C/h, time to target temperature was 60 (41; 195) min and the volume of iced fluids infused was 1607±858 ml (as compared with 2-2.5L historically). The percentage of time outside target temperature range during the maintenance phase was 6.5% (0.0; 29.0). Rewarming rate was 0.22 (0.18; 0.31)°C/h. No major adverse effects were observed.
Using the EHTD, our patient population attained goal temperatures in one hour, the volume of ice-cold saline required to attain this cooling rate was decreased by one-third, and experienced a low percentage of time outside target temperature range and no major adverse effects.
体温管理是心脏骤停昏迷幸存者复苏后护理的推荐组成部分。存在多种体温管理方法，所有这些方法都有局限性。我们旨在评估一种新型食管热传递装置（EHTD；美国伊利诺伊州芝加哥市高级冷却疗法公司）用于心脏骤停成年幸存者体温管理的性能和易用性。
我们在2015年3月至6月进行了一项前瞻性研究。我们的标准方案使用伺服控制水毯并辅以冰盐水，以便在1小时内达到目标温度（32°C - 34°C）。我们用EHTD替代了我们常用的水毯，然后记录随时间变化的体温和不良反应。
共治疗了14例患者，平均年龄65.1±13.7岁，体重中位数为75.5（70；83）kg。初始体温为35.3±1.2°C。诱导期的平均降温速率为1.12±0.62°C/小时，达到目标温度的时间为60（41；195）分钟，输注的冰液量为1607±858毫升（与历史上的2 - 2.5升相比）。维持期超出目标温度范围的时间百分比为6.5%（0.0；29.0）。复温速率为0.22（0.18；0.31）°C/小时。未观察到重大不良反应。
使用EHTD，我们的患者群体在1小时内达到了目标温度，达到该降温速率所需的冰盐水量减少了三分之一，超出目标温度范围的时间百分比很低，且未出现重大不良反应。
