Arctic Sun medical device

The Arctic Sun Temperature Management System is a non-invasive targeted temperature management system, a medical device used to modulate patient temperature with precision by circulating chilled water in pads directly adhered to the patient's skin. Using varying water temperatures and a sophisticated computer algorithm, a patient's body temperature can be controlled to the nearest 0.2 °C. It is produced by Medivance, Inc. of Louisville, Colorado.

Background

Body temperature, which is systematically measured and reported as a vital sign, contributes to maintenance of normal physiology and affects the processes that lead to recovery after illness. Complete and proper functioning of the body is dependent on maintaining a core temperature between 36.5–38.5 °C (97.7–101.3 °F). A core temperature above 41.5 °C or below 33.5 °C causes a fast decline in proper functioning of the body and may result in injury or death.[1] Intentional manipulation of body temperature has been studied as a treatment strategy for head injuries since the 1900s. In the 1980s, the use of hypothermia on dogs after cardiac arrest demonstrated positive outcomes including neurological status and survival. In 2005, the American Heart Association implemented recommendations and guidelines for mild hypothermia in post-resuscitation support after cardiac arrest with return of spontaneous circulation.[2]

One of the most common practices of targeted temperature management is to reduce body temperature to a “mild hypothermic state” (per the AHA guidelines is 33 °C (91.4 °F) for 12–24 hours and then slowly re-warm the body back to normal 37 °C (98.6 °F). The purpose of this is to slow the metabolic processes and the chemical cascade that occurs when the brain goes without oxygen for a period of time. A study conducted in 2002-2004 showed that treatment with therapeutic hypothermia for patients resuscitated after cardiac arrest due to ventricular fibrillation led to a positive outcome (Glasgow-Pittsburgh Cerebral Performance category 1 or 2) in 24 of 43 patients compared to only 11 of 43 patients in the standard resuscitation group where no hypothermia was used in treatment.[3]

Therapeutic hypothermia, which lowers the patient's body temperature to levels between 32–34 °C (90–93 °F), is used to help reduce the risk of the ischemic injury to the brain following a period of insufficient blood flow. Periods of insufficient blood flow may be caused by cardiac arrest, stroke, or brain trauma.[4] Non-invasively induced therapeutic hypothermia has been shown to reduce mortality of successfully resuscitated cardiac arrest victims by 35 percent and increase the chance of a good neurologic outcome by 39 percent.[5]

Device description

The Arctic Sun has been explained as dry water immersion. It is a non-invasive precision temperature management system that is used to induce hypothermia in comatose patients that have suffered from Sudden Cardiac Arrest (SCA) and patients at risk for ischemic brain damage. The Arctic Sun has distinctive gel pads, which stick to a patient's body using an adhesive called hydrogel—a substance that adheres to the skin without removing hair follicles. The gel pads cover only a portion of a patient's body and subsequently leave most of the body free for augmenting medical procedures. The device operates under negative pressure and circulates water through these pads at a temperature between 4–42 °C (39–108 °F). Water is pulled through the pads, which minimizes the risk of leakage. By controlling the temperature of the water running through the gel pads, the Arctic Sun adjusts a patient's temperature. Arctic Sun can also rewarm patients. Controlled rewarming has been cited in the literature as beneficial in preventing reperfusion injury. Because of the Arctic Sun's noninvasive nature, treatment can be delivered without the host of adverse events associated with invasive procedures such as cooling catheters.[6]

A former complaint levied against the Arctic Sun relates to the risk of skin injury. A study published in 2007 found that the Arctic Sun was, "highly effective in lowering patients’ temperature rapidly without inducing skin irritations.".[7]

Invasive cooling catheter companies have claimed that catheters can lower body temperature at a faster rate, which is relevant because most of the clinical data suggests that the sooner cooling initiates the better a patient’s outcome. However, there exists a 75 minute delay on average between admittance and catheter insertion. Even with a physician readily available to place the cooling catheter, the operating instructions underline the importance of the device set up which takes a minimum of 25 minutes. When objectively evaluating the published data the average cooling rate for cooling catheters is 1.12°C. Treatment with the Arctic Sun can be administered within 10 minutes by unsupervised nursing professionals.

Historically, clinicians reported that catheters cool at a quicker rate, however, a 2011 study published in the Society of Critical Care Medicine where 167 patients treated either with the Arctic Sun or the Alsius Coolgard Catheter showed the following:

There was no significant difference in survival with good neurologic function, either to hospital discharge or at follow-up. Time from cardiac arrest to achieving mild therapeutic hypothermia was equal with both devices (surface, 273 min, core, 270 min).”

  • Cooling was initiated immediately in the emergency department on hospital arrival with ice packs around groin, armpits and neck and infusion of up to 3 L of refrigerated saline
  • All patients were "deeply sedated"
  • No device-specific patient injuries were observed; skin injuries with the Arctic Sun or DVT with Coolgard
  • No differences in shivering: "
  • Article quote: "Skin temperature is known to influence thermoregulatory control, and it previously has been speculated that core cooling could result in less shivering.

However, this could not be confirmed in the present study, because there was no difference in the rate of shivering in surface-cooled or core-cooled patients.”

  • No differences were observed in Lengths of ICU stay, durations of respirator dependency, rates of MTH discontinuation, and post cooling

It was concluded that “Surface and core cooling of out-of hospital cardiac arrest patients following the same established postresuscitation treatment protocol resulted in similar survival to hospital discharge and comparable neurologic function at follow-up.”

Crit Care Med Vol 39 No 3

See also

References

  1. ↑ Moran, Daniel S.; Mendal, Liran (2002). "Core Temperature Measurement: Methods and Current Insights". Sports Medicine. 32 (14): 879–885. doi:10.2165/00007256-200232140-00001. PMID 12427049.
  2. ↑ McKean, Staci (2009). "Induced Moderate Hypothermia After Cardiac Arrest". AACN Advanced Critical Care. 20 (4): 342–53. doi:10.1097/NCI.0b013e3181bcea4e. PMID 19893373.
  3. ↑ Oddo, Mauro; Schaller, MD.; Feihl, F.; Ribordy, V.; Liaudet, L. (2006). "From evidence to clinical practice: Effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest". Critical Care Medicine. 34 (7): 1865–1873. doi:10.1097/01.CCM.0000221922.08878.49. PMC 2764536. PMID 16715035.
  4. ↑ Polderman Kees H (2004). "Application of therapeutic hypothermia in the ICU". Intensive Care Med. 30 (4): 556–575. doi:10.1007/s00134-003-2152-x. PMID 14767591.
  5. ↑ Holzer Michael (2002). "Mild Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest". New England Journal of Medicine. 346 (8): 549–56. doi:10.1056/nejmoa012689. PMID 11856793.
  6. ↑ Medivance
  7. ↑ Haugk Moritz; et al. (2007). "Feasibility and efficacy of new non-invasive cooling device in post resuscitation intensive care medicine". Resuscitation. 75 (1): 76–81. doi:10.1016/j.resuscitation.2007.03.001. PMID 17462808.
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