title: Oesophageal heat exchangers with a diameter of 11mm or 14.7mm are equally effective and safe for targeted temperature management.
abstract: BACKGROUND
  Targeted temperature management (TTM) is widely used in critical care settings for conditions including hepatic encephalopathy, hypoxic ischemic encephalopathy, meningitis, myocardial infarction, paediatric cardiac arrest, spinal cord injury, traumatic brain injury, ischemic stroke and sepsis. Furthermore, TTM is a key treatment for patients after out-of-hospital cardiac-arrest (OHCA). However, the optimal cooling method, which is quick, safe and cost-effective still remains controversial. Since the oesophagus is adjacent to heart and aorta, fast heat-convection to the central blood-stream could be achieved with a minimally invasive oesophageal heat exchanger (OHE). To date, the optimal diameter of an OHE is still unknown. While larger diameters may cause thermal- or pressure-related tissue damage after long-term exposure to the oesophageal wall, smaller diameter (e.g., gastric tubes, up to 11mm) may not provide effective cooling rates. Thus, the objective of the study was to compare OHE-diameters of 11mm (OHE11) and 14.7mm (OHE14.7) and their effects on tissue and cooling capability.
  
  
  METHODS
  Pigs were randomized to OHE11 (N = 8) or OHE14.7 (N = 8). After cooling, pigs were maintained at 33°C for 1 hour. After 10h rewarming, oesophagi were analyzed by means of histopathology. The oesophagus of four animals from a separate study that underwent exactly the identical preparation and cooling protocol described above but received a maintenance period of 24h were used as histopathological controls.
  
  
  RESULTS
  Mean cooling rates were 2.8±0.4°C°C/h (OHE11) and 3.0±0.3°C °C/h (OHE14.7; p = 0.20). Occasional mild acute inflammatory transepithelial infiltrates were found in the cranial segment of the oesophagus in all groups including controls. Deviations from target temperature were 0.1±0.4°C (OHE11) and 0±0.1°C (OHE14.7; p = 0.91). Rewarming rates were 0.19±0.07°C °C/h (OHE11) and 0.20±0.05°C °C/h (OHE14.7; p = 0.75).
  
  
  CONCLUSIONS
  OHE with diameters of 11 mm and 14.7 mm achieve effective cooling rates for TTM and did not cause any relevant oesophageal tissue damage. Both OHE demonstrated acceptable deviations from target temperature and allowed for an intended rewarming rate (0.25°C/h).
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany.
authors.forename: Daniel C
authors.identifier: http://orcid.org/0000-0002-0104-5986
authors.initials: DC
authors.lastname: Schroeder
authors.affiliation: Department of Experimental Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Guschlbauer
authors.affiliation: Department of Experimental Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: Maul
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Cremer
authors.affiliation: Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Becker
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany.
authors.forename: David
authors.initials: D
authors.lastname: de la Puente Bethencourt
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust. Queen Mary University of London, London, United Kingdom.|Barmherzige Brüder Salzburg Hospital, Department of Anaesthesiology and Critical Care Medicine, Kajetanerplatz 2, Salzburg, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Paal
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany.
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Padosch
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Wetsch
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Annecke
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany.
authors.forename: Bernd W
authors.initials: BW
authors.lastname: Böttiger
authors.affiliation: Department of Experimental Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Sterner-Kock
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, Cologne, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Herff
mesh_terms: D000818:Animals; D001831:Body Temperature; D003080:Cold Temperature; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D006358:Hot Temperature; D013552:Swine