Esophageal Temperature Management in Patients Suffering from Traumatic Brain Injury

Abstract

Traumatic brain injury (TBI) is a leading cause of death in the United States, and represents 2.5 million Emergency Department attendances, admissions into hospital, and deaths. A range of temperature modulating devices have been used to proactively cool TBI patients; however, there are currently no uniform targeted temperature management (TTM) guidelines in this patient population. Esophageal temperature management (ETM) is a relatively new TTM modality and the purpose of this study is to determine whether ETM is effective in controlling core temperature in TBI cases. This prospective interventional trial was a single-site study that enrolled 12 patients who received a TTM protocol using ETM. Eleven out of 12 patients reached target temperature during the first 10 hours of treatment. A total of 480 temperature measurements were recorded; 85% of the total measurements were within ±1°C of target temperature (408 measurements) and 75% were within ±0.5°C of target temperature (360 measurements). The average time to target was 5.83 ± 5.01 hours (range 1-20), with an average cooling rate of 0.58°C/h (range 0.15-1.5°C/h). This prospective interventional trial supports that ETM is a feasible TTM modality for severe TBI cases. The esophageal heat transfer device used in this study demonstrated comparable or superior performance to other commercially available TTM modalities, and the low adverse event rate may offer advantages over more invasive methods with reported higher complication rates.

Keywords: brain trauma; cooling strategies; esophageal temperature; heat transfer device; hyperthermia; targeted temperature management; temperature mechanisms; traumatic brain injury.

FIG. 1.

Esophageal temperature management device and system assembly.

FIG. 2.

Patient temperature curves for 12 patients during treatment.