• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information

TABLE 1Effect of head cooling on intracranial and/or core trunk temperature

TABLE 1aHeat loss from the upper airways – nasal airflow and intranasal evaporative coolant (Rhinochill, Benechill Inc., San Diego, CA, USA)

AuthorsType and purpose of studySubjectsHead-cooling interventionEffect of cooling on intracranial temperatureEffect of cooling on core trunk temperature
Andrews 2005,46 Harris 201057Randomised, controlled crossover trial of effect of restoration of nasal airflow on brain temperature in orally intubated patientsTBI and SAH (n = 15)30-minute baseline, randomised to 6-hour airflow or 6 hours of no airflow then crossed over for further 6 hours. Airflow: continuous through both nostrils at total rate of 115 ml/kg/minute (commensurate with normal minute volume), range 6–13 lParenchymal
Within-patient change in mean temperature with 6-hour airflow compared with 6 hours of no airflow −0.13 °C, SD 0.55 °C, 95% CI −0.43 °C to 0.17 °C.
Range of temperature change: +0.55 °C to −0.9 °C
Oesophageal
Not reported
Sung 2009,54 Abou-Chebl 201158 and unpublishedNon-randomised single group safety and feasibility study of intranasal cooling induction with the Rhinochill deviceStroke and TBI with clinical indication for cooling (n = 15)Intranasal cooling (Rhinochill) for 1 hour for fever control (n = 9) or neuroprotection/ICP reduction (n = 6) (followed by local standard cooling methods)Parenchymal
n = 11: mean reduction after 1 hour of cooling 1.4 ± 0.4 °C
Arterial, oesophageal, bladder or rectal
n = 15: mean reduction after 1 hour of cooling 1.1 ± 0.6 °C
Andreas 200855Prospective observational study of feasibility and safety of Rhinochill deviceCardiac arrest after ROSC (n = 7)Intranasal cooling (Rhinochill) for 1 hour (followed by cooling to 33 °C up to 24 hours with another device)N/AOesophageal
Median (first to third quartile) baseline temperature : 35.4 °C (34.7 °C to 36 °C)
After 1 hour: 34.1 °C (33.4 °C to 34.9 °C)
Difference: 1.3 °C
Cooling rate: 1.6 °C (1 °C to 1.7 °C)/hour
Busch 2008;56 201059Descriptive study of effectiveness, feasibility and safety of Rhinochill deviceCardiac arrest after ROSC (n = 84)Intranasal cooling (Rhinochill) device for 1 hour (range 25–195 minutes) (followed by cooling to 33 °C up to 12–24 hours with a systemic device)N/AArterial, oesophageal, bladder or rectal
Cooling rate median (first to third quartile): 1.1 °C (0.7 °C to 1.5 °C)/hour
PRINCE trial
Castrén 2009;60 201049
RCT of safety, feasibility, cooling efficacy of Rhinochill deviceWitnessed out-of-hospital cardiac arrest pre-ROSC (n = 194); 93 cooled (75 survived to hospital), 101 uncooled control patients (42 survived to hospital)Intranasal cooling (Rhinochill) started during arrest and continued until after hospital arrival (median duration 32 minutes), target temperature 34 °CN/ARectal, bladder or intravascular
Mean difference between cooled (n = 75) and control patients (n = 42) after hospital admission: −0.7 °C (p = 0.01)

PRINCE, Pre-ROSC IntraNasal Cooling Effectiveness.

TABLE 1bHeat loss from the upper airways – nasal airflow and intranasal evaporative coolant (Rhinochill): heat loss through the upper airways and through the skull – nasal airflow and/or head fanning

AuthorsType and purpose of studySubjectsHead-cooling interventionEffect of cooling on intracranial temperatureEffect of cooling on core trunk temperature
Harris 2007;47 201057Randomised controlled crossover factorial trial of effect on temperature of enhanced nasal airflow and bilateral head fanningTBI and SAH (n = 12)Thirty-minute baseline, each of four interventions in random order for 30 minutes with washout between (1) enhanced nasal airflow, (2) head fanning (no head bandages), (3) (1) + (2), and (4) no intervention
1 = continuous unhumidified airflow through both nostrils at twice the patient’s ventilated minute volume + 20 ppm nitric oxide
2 = bilateral head fanning with ambient air, total air speed approximately 8 m s−1
Parenchymal
Difference in mean temperature over last 5 minutes of preceding washout minus mean over last 5 minutes of intervention = 0.15 °C with nasal airflow (p = 0.001, 95% CI 0.06 °C to 0.23 °C) and 0.26 °C with head fanning (p < 0.001, 95% CI 0.17 °C to 0.34 °C)
Estimate of combined effect of airflow and fanning on temperature = 0.41 °C
Oesophageal
Difference in mean temperature over the last 5 minutes of preceding washout minus mean over the last 5 minutes of intervention = 0.13 °C with nasal airflow (p = 0.005, 95% CI 0.04 °C to 0.21 °C) and 0.19 °C with head fanning (p < 0.001, 95% CI 0.11 °C to 0.28 °C)
Estimate of combined effect of airflow and fanning on temperature = 0.32 °C

TABLE 1cHeat loss through the skull – passive conductive methods – ice packs

AuthorsType and purpose of studySubjectsHead-cooling interventionEffect of cooling on intracranial temperatureEffect of cooling on core trunk temperature
Callaway 200248RCT with convenience sample of pre-hospital head cooling during cardiac arrestOut-of-hospital cardiac arrest (n = 27); 14 cooled (5 excluded from analysis because of incomplete temperature data); 13 uncooled control patientsHead cooling with three 500-ml bags of ice applied to head + one across neck (duration 5–10 minutes)N/AOesophageal
Cooled group mean baseline: 35.5 ± 1.0 °C; control patients 35.3 ± 1.7 °C; temperatures at end of cooling not reported
Mean rate of temperature change in cooled group: 0.07 ± 0.06 °C/minute (95% CI −0.11 to −0.03)
Mean change in control patients: 0.02 ± 0.06 °C/ minute (95% CI −0.05 to 0.02)
Difference: −0.05 °C/ minute (95% CI −0.106 to 0.007)
Forte 200952Retrospective study of the effect of ice packs on ICP and brain temperature – not reported if prospective or retrospectiveTBI, SAH, stroke, brain tumour, after decompressive craniectomy for refractory intracranial hypertension (n = 23)Ice packs over decompressive craniectomy site, duration 61.7 hours (range 20–96 hours) depending on ICP and CTIntracranial: Mean at baseline 37.1 °C (range 35.3–38.9 °C), mean over 48 hours of cooling 35.2 °C (range 33.6–37.6 °C); range of temperature change with cooling +0.3 °C to −4.5 °COesophageal
Not reported

TABLE 1dHeat loss through the skull – active conductive methods – head and neck liquid cooling devices

AuthorsType and purpose of studySubjectsHead- and neck-cooling interventionEffect of cooling on intracranial temperatureEffect of cooling on core trunk temperature
COOL BRAIN Stroke Trial Wang 2003;61 2004;50 200462Prospective, non-randomised pilot trial of the effectiveness of head cooling in reducing brain temperatureStroke + ≥ 1 TBI (n = 14); 8 cooled, 6 ‘control patients’ (not reported here)Pressurised liquid cooling helmet, temperature of coolant not reported, heads shaved
Cooling duration unclear – up to 72 hours. Active body warming to maintain bladder temperature > 33 °C, 35 °C if aged > 45 years
Parenchymal
Mean brain temperature reduction 1.84 °C (range 0.9–2.4 °C) within 1 hour
Note: Active body warming
Bladder: Not reported
Mean brain minus bladder temperature difference during cooling = −1.6 °C
Harris 200945RCT to evaluate a head-cooling device in the management of TBITBI (n = 25); 11 cooled, 10 uncooled control patients (missing temperature data n = 4)Pressurised liquid cooling helmet, coolant temperature not reported, heads not shaved, duration 24 hours, target intracranial temperature 33 °C, active body warming to maintain bladder temperature 36 °CParenchymal or ventricular
Cooled group:
Mean baseline = 37.9 °C; at 12 hours, 36.8 °C; at 24 hours, 36.9°C
Control patients:
Mean baseline and 12 hours, 37.9°C; at 24 hours 38.1°C; difference from baseline in cooled group at 12 hours = 1.1°C, at 24 hours = 1°C
12-hour mean difference between cooled patients and control patients = −1.1 °C, at 24 hours −1.2 °C
Note: Active body warming
Bladder
Not reported
Mean intracranial minus bladder temperature over the 24-hour cooling period: −0.67 °C in the cooled group; +0.05 °C in the control patients (neither statistically significant)
Gaida 200851Observational study of head cooling for refractory fever managementSAH (n = 6)Liquid cooling helmet (CSZ Blanketrol) for brain temperature > 37.8 °C after 2 hours of standard fever management, duration 6 hoursVentricular
Mean baseline = 38.5 ± 0.6 °C
Mean at 6 hours = 37.5 ± 0.4 °C
Difference = 1 °C
Arterial
Mean baseline = 38.2 ± 0.6 °C
Mean at 6 hours = 37.4 ± 0.5 °C
Difference 0.8 °C
TraumaTec Neuro-Wrap Neuro ICU Study
Miller 200953 and unpublished
Descriptive single group study to determine rate and degree of brain cooling with TraumaTec Neuro-WrapBrain injury
Interim data on n = 9, study aim n = 20
Liquid cooling helmet (TraumaTec Neuro-Wrap) for 8 hours
Target temperature N/A
Intracranial
Mean baseline temperature 37.5 ± 1 °C
Lowest temperature 35.5 ± 1.4 °C
Difference 2.0 °C
Body temperature remained between 36.7 °C and 37.8 °C

From: 4, Results

Cover of Systematic Review of Head Cooling in Adults After Traumatic Brain Injury and Stroke
Systematic Review of Head Cooling in Adults After Traumatic Brain Injury and Stroke.
Health Technology Assessment, No. 16.45.
Harris B, Andrews PJD, Murray GD, et al.
© 2012, Crown Copyright.

Included under terms of UK Non-commercial Government License.

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.