Introduction:
Optimal patient care after cardiac arrest includes targeted temperature management (TTM). Methods typically utilized for patient temperature control, including ice-packs, servo-controlled surface pads, and intravascular catheters. A new device placed in the esophagus that cools from the patient’s core may offer advantages over other methods. It avoids risks from intravascular catheters, reduces shivering from surface contact, and allows core temperature control to be rapidly performed, after placement, by nursing staff.
Hypothesis:
Using a nurse driven protocol we sought to quantify patient outcomes, after TTM, using an esophageal device, in our mixed-population intensive care unit.
Methods:
We reviewed the charts of all patients treated with esophageal TTM as part of our standard post-arrest bundle at our advanced community medical center. We recorded patient age, gender, target temperature, TTM initiation time, the time goal temperature was attained, and patient survival.
Results:
A total of 54 patients were treated with esophageal TTM over the study period, from August 2016 to November 2018. Of these 2 recovered and had treatment discontinued prior to reaching target, leaving 52 for analysis (19 female, 33 male, age 18-79, median age 62.5). Nurses placed all ETM devices, and target temperatures varied by clinician preference, from 32°C to 36°C. Survival to ICU discharge was 51.9% for the entire cohort, with male survival (61%) greater than female (37%), p=0.10; however, Cfor the entire cohort was 219 minutes (IQR 81-415). Survivors exhibited longer times to achieve goal temperature (median 180 minutes in non-survivors vs. 255 minutes in survivors).
Conclusions:
Esophageal TTM offers a nurse-driven approach to obtain rapid core temperature management, with good outcomes in our patient population. As seen elsewhere, surviving patients require longer times to reach target temperature.
Management of temperature control in post-cardiac arrest care: an expert report
