When is a cooling blanket used




















Cardiac arrest happens when the heart suddenly stops beating. Once the heart starts beating again, healthcare providers use cooling devices to lower your body temperature for a short time. The treatment usually lasts about 24 hours. The heart has an electrical signal that helps coordinate the heartbeat. If this signal is disrupted or abnormal, the heart may not be able to pump the right way.

That can result in cardiac arrest. Cardiac arrest is not the same thing as a heart attack. Sometimes cardiac arrest happens after a heart attack. But it can also happen without one. The brain may also not get enough blood. The lack of blood flow can cause lasting damage to the brain. The person may be unable to regain consciousness.

Lowering the body temperature right away after cardiac arrest can reduce damage to the brain. That raises the chances that the person will recover. Therapeutic hypothermia can help only some people who have had cardiac arrest. Some people regain consciousness right after cardiac arrest. These people often do not need this procedure. It is helpful only for people whose heartbeat returns after a sudden cardiac arrest. Therapeutic hypothermia can be a good choice if the heart restarted but you are still not responsive.

It can raise the chance that you will wake up. Recently viewed grants:. Recently added grants:. Funding Agency. Name University of Cincinnati. Related projects. A hypothermia blanket keeps the body at the lowered temperature for varying periods of time, depending on the condition being treated.

After treatment, the patient is slowly warmed until the internal body temperature reaches the normal range. The patient can lay on top or underneath the hypothermia blanket. Occasionally, two blankets are used — one on top as well as one beneath. There are several limitations to this study. The nursing staff and attending doctors could not be blinded to treatment allocation for obvious practical reasons. It is unlikely that this would have influenced the outcomes of this study since the cooling devices were operated strictly according to the operators' manuals, and temperatures were recorded automatically.

The use of sedatives, analgesics and neuromuscular blocking agents differed between the groups. These drugs were administered only in case of shivering and distress, and their prescription was left to the discretion of the attending medical staff not involved in this clinical trial.

In humans, core temperature is normally maintained within a tight range. A reference temperature set point generated by a network of warm, cold, and thermal insensitive neurons in the pre-optic area is compared with feedback from the skin and core thermoreceptors.

An error signal, proportional to the difference between the set point and feedback signal, is generated, which activates thermoeffector pathways, including vasoconstriction and shivering. A larger difference between set point and feedback signal will thus result in more intense vasoconstriction and shivering.

This was also the case in our trial: the devices that resulted in a stronger decrease of the feedback signal induced shivering more frequently.

In this study, patients were sedated to a Ramsay score of 6 and received adequate analgesia with morphine or fentanyl. If patients exhibited clinical signs of shivering, they were treated with extra sedation, morphine or muscle relaxation.

In our ICU, this is the normal protocol in patients that need temperature management. Most studies that compare different cooling devices use a similar protocol of sedation and relaxation [ 19 - 24 ].

In those studies as well as in our study, patients treated with the most efficient cooling device needed more sedation and relaxation. Since this was caused by the stronger temperature decline in these patients, differences in use of sedation and relaxation is considered a consequence rather than cause of efficient cooling.

Pulmonary artery core temperature is considered the gold standard for measurement of core body temperature [ 25 - 28 ]. A major disadvantage is the invasive nature of this technique and its relatively high cost.

Rectal temperature is comparable to pulmonary artery core temperature mean difference of 0. This technique was chosen because it is common practice in most ICUs. In addition, the water-circulating cooling device, the gel-coated external cooling system and the endovascular cooling system are all equipped with an automatic temperature control device based on the patient's rectal temperature. Previous studies comparing different devices also used non-invasive temperature measurement.

To ensure that the results of this study are applicable to most ICUs and comparable to previous studies, we chose to measure temperature in a non-invasive way.

The results of our study demonstrate that water-circulating blankets, gel-coated water circulating pads and intravascular cooling are equally efficient in inducing hypothermia and normothermia. For maintaining the target temperature, intravascular cooling is superior to all other cooling methods.

All authors participated in the design and coordination of the study and draft of the manuscript. All authors read and approved the final manuscript. National Center for Biotechnology Information , U. Journal List Crit Care v. Crit Care. Published online Aug Author information Article notes Copyright and License information Disclaimer.

Corresponding author. Cornelia W Hoedemaekers: ln. C ; Mustapha Ezzahti: ln. M ; Aico Gerritsen: ln. A ; Johannes G van der Hoeven: ln. This article has been cited by other articles in PMC. Abstract Background Temperature management is used with increased frequency as a tool to mitigate neurological injury. Methods Fifty adult ICU patients with an indication for controlled mild hypothermia or strict normothermia were prospectively enrolled. Results Temperature decline was significantly higher with the water-circulating blankets 1.

Conclusion Cooling with water-circulating blankets, gel-pads and intravascular cooling is more efficient compared to conventional cooling and air-circulating blankets. Introduction Temperature management is used with increasing frequency as a tool to mitigate neurological injury. Materials and methods Study population A total of 50 consecutive adult patients with an indication for controlled mild hypothermia or strict normothermia were prospectively enrolled.

Study intervention Ten patients in each group were prospectively assigned to conventional cooling, cooling with a water circulating external cooling device Blanketrol II, Cincinatti Subzero, The Surgical Company, Amersfoort, The Netherlands , an air circulating external cooling device Caircooler CC, Medeco, Oud-Beijerland, The Netherlands , a water circulating external cooling device using self-adhesive gel-coated pads Arctic Sun, Medivance, Jugenheim, Germany or an intravascular heat exchange system Icy-catheter, Alsius Coolgard , Medicor, Nieuwegein, The Netherlands.

Standard care All patients were admitted to the ICU, monitored and treated according to international standards. Data collection Demographic, clinical, laboratory and pharmacological data were obtained through review of the medical records of the patients.

Statistical analysis Power calculation was based on previous tests using the water-circulating cooling device and conventional cooling with ice and coldpacks. Results Baseline characteristics A total of 50 patients were enrolled in the study.

Table 1 Baseline characteristics of patients in the hypothermia and normothermia groups. Open in a separate window. Figure 1. Table 2 Patient characteristics during cooling to hypo- and normothermia in the hypothermia and normothermia groups. Maintaining hypo- and normothermia After the target temperature was reached, we measured the percentage of time the patient's temperature was 0.

Figure 2. Figure 3.



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