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Clin Neurol Neurosurg. 2019 Sep;184:105412. doi: 10.1016/j.clineuro.2019.105412. Epub 2019 Jul 2.

The EMCOOLs surface cooling system for fever control in neurocritical care patients: A pilot study.

Author information

1
Mount Sinai Hospital Neuro-ICU, Neurocritical Care Division, Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address: griffo.stephen@gmail.com.
2
Mount Sinai Hospital Neuro-ICU, Neurocritical Care Division, Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address: javaad.a@gmail.com.
3
Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine) and Department of Critical Care, CHU de Québec-Université Laval, Québec, Canada. Electronic address: charles-langis.francoeur.2@ulaval.ca.
4
Mount Sinai Hospital Neuro-ICU, Neurocritical Care Division, Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Departments of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States; St. John Ascension Health System, Tulsa, OK, United States. Electronic address: errolgordonjr@gmail.com.
5
Mount Sinai Hospital Neuro-ICU, Neurocritical Care Division, Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Departments of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address: Neha.Dangayach@mountsinai.org.
6
Departments of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address: danielle.wheelwright@mountsinai.org.
7
Mount Sinai Hospital Neuro-ICU, Neurocritical Care Division, Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address: anil.ramineni@gmail.com.
8
Department of Neurology, Henry Ford Health System, Wayne State School of Medicine, Detroit, MI, United States. Electronic address: smayer2@hfhs.org.

Abstract

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 ⁰C, T90avg = 37.6 ⁰C, P = 0.0032) in mean temperature over 90 min, followed by a plateau with only one subject rebounding to >38 °C within 4 h. Normothermia (<38.0 ⁰C) was achieved in all but one patient (92%) in an average of 65 min. Comatose patients displayed a non-significantly higher degree of cooling at 90 min than did awake subjects (ΔTcoma = 1.74 °C vs ΔTawake = 0.74 °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.

KEYWORDS:

Brain injury; Fever; Intracerebral hemorrhage; Stroke; Subarachnoid hemorrhage; Surface cooling; Targeted temperature management

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