A novel thermal compression device for perioperative warming: a randomized trial for feasibility and efficacy

Background: Inadvertent perioperative hypothermia (IPH) leads to surgical complications and increases length of stay. IPH rates are high with the current standard of care, forced air warming (FAW). Our hypothesis is that a prototype thermal compression device that heats the popliteal fossa and soles of the feet, with lower leg compression, increases perioperative temperatures and reduces IPH compared to the current standard of care. Methods: Thirty six female breast surgery patients, at a tertiary academic hospital, were randomized to the device or intraoperative FAW (stage I) with a further 18 patients randomized to the device with a single heating area only (stage II, popliteal fossa or sole of the feet). Stage I: 37 patients recruited (final 36). Stage II: 18 patients recruited (final 18). Inclusion criteria: general anesthesia with esophageal monitoring for over 30 min, legs available and able to fit the device and no contraindications to leg heating or compression. The intervention was: Stage I: Investigational prototype thermal compression device (full device group) or intraoperative FAW. Stage II: Device with only a single heating location. Primary outcomes were perioperative temperatures and incidence of IPH. Secondary outcomes were local skin temperature, general and thermal comfort scores and presence of perioperative complications, including blood loss. Results: Mean temperatures in the full device group were significantly higher than the FAW group in the preoperative (36.7 vs 36.4 degrees C, p < 0.001), early intraoperative (36.3 vs 35.9 degrees C, p < 0.001), intraoperative (36.6 vs 36.2 degrees C, p < 0.001) and postoperative periods (36.8 vs 36.5 degrees C, p < 0.001). The incidence of IPH in the device group was also significantly lower (16.7% vs 72.0%, p = 0.001). Thermal comfort scores were significantly higher in the full device group and hypothermia associated wound complications were higher in the FAW group. Conclusions: The thermal compression device is feasible and has efficacy over the FAW. Further studies are recommended to investigate clinically significant outcomes.