Esophageal Cooling Device Versus Other Temperature Modulation Devices for Therapeutic Normothermia in Subarachnoid and Intracranial Hemorrhage

Abstract

Achieving and maintaining normothermia (NT) after subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) often require temperature modulating devices (TMD). Shivering is a common adverse effect of TMDs that can lead to further costs and complications. We evaluated an esophageal TMD, the EnsoETM (Attune Medical, Chicago, IL), to compare NT performance, shiver burden, and cost of shivering interventions with existing TMDs. Patients with SAH or ICH and refractory fever were treated with the EnsoETM. Patient demographics, temperature data, shiver severity, and amounts and costs of medications used for shiver management were prospectively collected. Controls who received other TMDs were matched for age, gender, and body surface area to EnsoETM recipients, and similar retrospective data were collected. All patients were mechanically ventilated. Fever burden was calculated as areas of curves of time spent above 37.5°C or 38°C. Demographics, temperature data, and costs of EnsoETM recipients were compared with recipients of other TMDs. Eight EnsoETM recipients and 24 controls between October 2015 and November 2016 were analyzed. There were no differences between the two groups in demographics or patient characteristics. No difference was found in temperature at initiation (38.7°C vs. 38.5°C, p = 0.4) and fever burden above 38°C (-0.44°C × hours vs. -0.53°C × hours, p = 0.47). EnsoETM recipients showed a nonsignificant trend in taking longer to achieve NT than other TMDs (5.4 hours vs. 2.9 hours, p = 0.07). EnsoETM recipients required fewer shiver interventions than controls (14 vs. 30, p = 0.02). EnsoETM recipients incurred fewer daily costs than controls ($124.27 vs. $232.76, p = 0.001). The EnsoETM achieved and maintained NT in SAH and ICH patients and was associated with less shivering and lower pharmaceutical costs than other TMDs. Further studies in larger populations are needed to determine the EnsoETM's efficacy in comparison to other TMDs.

Keywords: esophageal cooling device; intracerebral hemorrhage; normothermia; subarachnoid hemorrhage; targeted temperature management.

Conflict of interest statement

N.B. reports research support from C.R. Bard, Inc. and from the Maryland Industrial Partnerships Program (MIPS 6021) outside the submitted work. N.B. is also cochair for the TTM Guideline Committee for the Neurocritical Care Society. J.H. reports grants from Maryland Industrial Partnerships Program (MIPS 6021) outside the submitted work. No other authors report any conflicts of interest.

Figures

FIG. 1.

Initiation phase (initial 120 minutes) of induction of normothermia in EnsoETM recipients.

FIG. 2.

Average daily and total costs (in US$) per patient, grouped into EnsoETM recipients versus other TMD recipients (control). ECD, esophageal cooling device (EnsoETM); TMD, temperature modulating device.