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Randomized Controlled Trial
. 2023 Jun;80(6):339-345.
doi: 10.1136/oemed-2022-108457. Epub 2023 May 4.

Cooling vest improves surgeons' thermal comfort without affecting cognitive performance: a randomised cross-over trial

Jill E Byrne  1 , Fabio Andres Rodriguez-Patarroyo  2 , Edward J Mascha  2   3 , Yanyan Han  2   3 , Mauro Bravo  2 , Michael R Bloomfield  2 , Stephen M Rao  2 , Daniel I Sessler  2
Affiliations
Randomized Controlled Trial

Cooling vest improves surgeons' thermal comfort without affecting cognitive performance: a randomised cross-over trial

Jill E Byrne et al. Occup Environ Med. 2023 Jun.

Abstract

Objectives: Surgeons become uncomfortable while performing surgery because heat transfer and evaporative cooling are restricted by insulating surgical gowns. Consequently, perceptions of thermal discomfort during surgery may impair cognitive performance. We, therefore, aimed to evaluate surgeons' thermal comfort, cognitive performance, core and mean skin temperatures, perceptions of sweat-soaked clothing, fatigue and exertion with and without a CoolSource cooling vest (Cardinal Health, Dublin, Ohio, USA).

Methods: Thirty orthopaedic surgeons participated in a randomised cross-over trial, each performing four total-joint arthroplasties with randomisation to one of four treatment sequences. The effects of cooling versus no cooling were measured using a repeated-measures linear model accounting for within-subject correlations.

Results: The cooling vest improved thermal comfort by a mean (95% CI) of -2.1 (-2.7 to -1.6) points on a 0-10 scale, p<0.001, with no evidence of treatment-by-period interaction (p=0.94). In contrast, cooling had no perceptible effect on cognition, with an estimated mean difference (95% CI) in Cleveland Clinic Cognitive Battery (C3B) Processing Speed Test score of 0.03 (95% CI -2.44 to 2.51), p=0.98, or in C3B Visual Memory Test score with difference of 0.88 (95% CI -2.25 to 4.01), p=0.57. Core temperature was not lower with the cooling vest, with mean difference (95% CI) of -0.13 (-0.33°C to 0.07°C), p=0.19, while mean skin temperature was lower, with mean difference of -0.23 (95% CI -0.40°C to -0.06°C) lower, p=0.011. The cooling vest significantly reduced surgeons' perceptions of sweat-soaked clothing, fatigue and exertion.

Conclusions: A cooling vest worn during surgery lowered core and skin temperatures, improved thermal comfort, and decreased perceptions of sweating and fatigue, but did not improve cognition. Thermal discomfort during major orthopaedic surgery is thus largely preventable, but cooling does not affect cognition.

Trial registration number: NCT04511208.

Keywords: Differential Thermal Analysis; Health Personnel; Occupational Stress; Personal Protective Equipment; Physical Exertion.

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Conflict of interest statement

Competing interests: SMR receives royalties regarding the C3B software. JEB receives royalties regarding the CoolSource Cooling system and as a co-principal investigator, an investigator initiated study grant was received from Cardinal Health to study the CoolSource Cooling System. No other authors have any competing interests.

Figures

Figure 1
Figure 1
Mean skin temperature over time by treatment. Data points represent means±SDs of mean skin temperature for a case, ignoring surgeon and period.
Figure 2
Figure 2
Core body temperature over time by treatment. Data points represent means±SDs of mean skin temperature for a case, ignoring surgeon and period.
See this image and copyright information in PMC

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