Surface Cooling System for Fever Control in Neurocritical Care Patients: A Pilot Study
Griffiths SA, Ahmad J, Francoeur CL, Gordon E, Dangayach NS, Wheelwright D, Ramineni A, and Mayer SA. The EMCOOLs Surface Cooling System for Fever Control in Neurocritical Care Patients: A Pilot Study. Clin Neurol Neurosurg 2019.
Clinical neurology and neurosurgery
OBJECTIVES: Fever occurs in up to 50% of critically-ill patients with acute neurological injury. Small temperature elevations have been correlated with increased morbidity and mortality in this patient population. We sought to evaluate a novel single-use surface cooling system for the treatment of fever in patients with acute brain injury.
PATIENTS AND METHODS: We conducted a retrospective analysis of a prospective product evaluation using the EMCOOLS Flex.Pad™ system for acute fever (≥38.3 °C) in our 16-bed neuro-ICU. Four refrigerated pads (-18 °C) were applied to the chest, back, and anterior thighs. Core temperature (bladder) was continuously recorded over 4 h, and the highest Bedside Shivering Assessment Scale (BSAS) score was recorded hourly.
RESULTS: Twelve subjects were included in the analysis. Mean age was 55 ± 9 years, 9 patients were men, and mean weight was 85 ± 12 kg. The most common primary diagnoses were subarachnoid (N = 5) and intracerebral (N = 4) hemorrhage. Application of the EMCOOLS system resulted in a linear 1.3 ± 0.6 °C drop (T0avg=38.9 (0)C, T90avg=37.6 (0)C, P=0.0032) in mean temperature over 90min, followed by a plateau with only one subject rebounding to >38 degrees C within 4h. Normothermia (<38.0 (0)C) was achieved in all but one patient (92%) in an average of 65min. Comatose patients displayed a non-significantly higher degree of cooling at 90min than did awake subjects (DeltaTcoma=1.74 degrees C vs DeltaTawake=0.74 degrees C hr(-1), P=0.067). There was no observed skin irritation upon removal of the device for any patients.
CONCLUSION: The EMCOOLs system is a well-tolerated, safe and effective short-term intervention for control of fever in neurological patients. Future studies are needed to compare efficacy of the EMCOOLs to other devices and interventions.
ePub ahead of print