Targeted temperature management using the Esophageal Cooling Device after cardiac arrest (the COOL study): A feasibility and safety study

Background: Targeted temperature management (TTM) between 32 and 36 degrees C is recommended after out-of-hospital cardiac arrest (OHCA). We aimed to assess the feasibility and safety of the Esophageal Cooling Device (ECD) in performing TTM. Patients and methods: This single-centre, prospective, interventional study included 17 comatose OHCA patients. Main exclusion criteria were: delay between OHCA and return of spontaneous circulation (ROSC) >60 min, delay between sustained ROSC and inclusion >360 min, known oesophageal disease. A TTM between 32 and 34 degrees C was performed using the ECD (Advanced Cooling Therapy, USA) connected to a heat exchanger console (Meditherm III (R), Gaymar, France), without cold fluids' use. Primary end-point was feasibility of inducing, maintaining TTM, and rewarming using the ECD alone. Secondary endpoints were adverse events, focusing on potential digestive damages. Results were expressed as median (interquartiles 25-75). Results: Cooling rate to reach the Target Temperature (33 degrees C-TT) was 0.26 degrees C/h [0.19-0.36]. All patients reached the 32-34 degrees C range with a time spent within the range of 26 h [21-28] (3 patients did not reach 33 degrees C). Temperature deviation outside the TT during TTM-maintenance was 0.10 degrees C [0.03-0.20]. Time with deviation >1 degrees C was 0 h. Rewarming rate was 0.20 degrees C/h [0.18-0.22]. Among the 16 gastrointestinal endoscopy procedures performed, 10 (62.5%) were normal. Minor oeso-gastric injuries (37.5% and 19%, respectively) were similar to usual orogastric tube injuries. One patient experienced severe oesophagitis mimicking peptic lesions, not cooling-related. No patient among the 9 alive at 3-month follow-up had gastrointestinal complains. Conclusion: ECD seems an interesting, safe, accurate, semi-invasive cooling method in OHCA patients treated with 33 degrees C-TTM, particularly during the maintenance phase. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.