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Table 3 Studies performing target temperature management in acute cardiovascular events

From: Insight into the use of tympanic temperature during target temperature management in emergency and critical care: a scoping review

Study Pathology Population Cooling approach Setting Tympanic TM device Core TM sites Other TM sites Main results
Feasibility Comparability
Busch et al. [44] CA N: 84
Age: 71 (63; 79) y
Male: 76%
Post-ROSC trans-nasal cooling.
TT: 33 °C (tympanic and esophageal).
ED/ ICU IRTT, ThermoScan Pro 4000, Braun GmbH, Germany Esophageal, or arterial, or bladder, or rectal None TTy displayed a cooling rate of 2.3 (1.6; 3.0) °C/h. The cooling time to reach the tympanic TT was 60 (36.5; 117.5) min and was reached in 66% of pts. The cooling rate of overall core sites (esophageal, arterial, bladder, or rectal) was 1.1 (0.7; 1.5) °C/h, with a faster response for esophageal or arterial (1.4 (0.9; 2.0) °C/h) than for bladder or rectal (0.9 (0.5; 1.2) °C/h; p=0.001). The cooling time to reach the core TT was 180 (120; 285) min and was reached in 19% of patients.
Callaway et al. [45] OHCA Intervention:
N: 9
Age: 68 ± 15 y
Male: 100%
Control:
N: 13
Age: 80 ± 10 y
Male: 71%
Intervention:
intra-arrest head and neck cooling.
TT: 34 °C (esophageal).
Control:
standard care.
PH/ ED IRTT, NR. Esophageal Naso-pharyngeal TTy displayed unpredictable variations due to ice in the ears. NR
Castren et al. [46] OHCA Intervention:
N: 93
Age: 66 y
Male: 72%
Control:
N: 101
Age: 64 y
Male: 78%
Intervention:
intra-arrest trans-nasal cooling.
TT: 34 °C (tympanic and core).
Control:
standard care.
PH IRTT, NR Rectal, or bladder, or intravascular None TTy at hospital arrival was significantly different (p<0.001) in intervention (34.2±1.5 °C) vs. control (35.5±0.9 °C). The cooling rate was 1.3 °C in 26 min. The cooling time to reach the tympanic TT was significantly shorter (p=0.03) in the intervention (102 (81; 155) min) vs. the control (291(183; 416) min) group. Core T (rectal, or bladder, or intravascular) at admission was 35.1±1.3 °C in intervention vs. 35.8 °C ± 0.9 °C in control (p<0.01). Cooling time to reach the core TT was 155 (124; 315) min in the intervention vs. 284 (172; 471) in the control group.
Hasper et al. [47] OHCA N: 10
Age: 71.5 y§
Male: 80%
Post-ROSC whole body
cooling by cold saline infusion and water pads.
TT: 33 °C (NR).
ED IRTT, Braun ThermoScan pro4000; Welch Allyn, Germany Esophageal, or bladder None During TTM TTy was 33.40 {33.30; 33.60} °C. TTy displayed a small bias with respect to esophageal T (0.021 °C ± 0.80 °C) and a high significant correlation with esophageal (r=0.95, p<0.0001) and bladder T (r=0.96, p<0.0001).
Hachimi-Idrissi et al. [48] OHCA Intervention:
N: 16
Age: 77 [52; 95] y
Male: 56%
Control:
N: 14
Age: 74 [59; 91] y
Male: 64%
Intervention:
head and neck cooling.
TT: 34 °C (bladder).
Control:
standard care.
ED IRTT, Braun Thermoscan, Braun, Germany Central venous, arterial, or bladder Scalp The cooling time to reach the tympanic TT in intervention was 60 (15; 240) min. The cooling time to reach the bladder TT was longer, 180 (70; 240) min (p = NR).
Islam et al. [49] OHCA Intervention:
N: 37
Age: 64 ± 12 y
Male: 86%
Control:
N: 37
Age: 62 ± 13 y
Male: 74%
Intervention:
post-ROSC intra-nasal cooling.
TT: 34 °C (tympanic and esophageal).
Control: standard surface-cooling.
TT: 34 °C (tympanic and esophageal).
CL by direct admission NR Esophageal None In the first cooling hour, TTy showed a significantly larger drop (1.75 °C) in intervention vs. control (0.935 °C, p<0.01).
The cooling time to reach the tympanic TT was 75.2 min in intervention vs. 107.2 min in control (p=NS).
Esophageal T drop in the first hour was not significantly different in intervention (1.148 °C) vs. control (0.904 °C, p = NS).
The cooling time to reach the esophageal TT was 84.7 min in intervention vs. 114.9 min in control (p=NS).
Krizanac et al. [50] OHCA N: 20
Age: 63 (43; 88) y
Male: 80%
Post-ROSC cooling by cooling pads, or intravascular cooling catheters and intravenous cold saline infusion.
TT: 33 °C (esophageal).
ED Thermistor thermometer, Mon-a-Therm, Tyco Healthcare, UK. Esophageal, bladder, pulmonary artery, or femoral-iliac artery None TTy tracked temperature changes induced by cooling but continuously and substantially underestimated the pulmonary artery T during cooling as well as during steady state. The bias of TTy compared to pulmonary artery T were -0.6 {−0.8; −0.3} °C (overall) and −0.6 {−0.8; −0.4}°C (cooling phase). The tympanic TT was reached with an anticipation of −38 {−65; −23.5} min compared to the pulmonary artery.
Shin et al. [51] OHCA N: 21
Age: 50 ± 20 y
Male: 71%
Post-ROSC cooling by cold saline infusion and external cooling pads.
TT: 33 °C (bladder).
ED Thermistor thermometer, Probe 400 Series, DeRoyal, USA; inserted after otoscopic exam, taped in place, covered with bandage. Rectal, bladder, or pulmonary artery None TTy tracked the changes induced by cold saline cooling, but it underestimated pulmonary artery T through the whole procedure. The bias$ of TTy compared to pulmonary artery was: −1.03 ± 1.47 °C (overall), −1.11 ± 1.53 °C (induction phase), −1.12 ± 1.29 °C (maintenance phase), and −0.89 ± 1.62 °C (rewarming phase). The correlation was: 0.860 (overall), 0.815 (induction phase), 0.611 (maintenance phase), and 0.776 (rewarming phase).
Stratil et al. [52] CA Winter group (outside T ≤ 10 °C):
N: 61
Age: 60 (50; 75) y
Male: 70%
Summer group:
(outside T ≥ 20 °C):
N: 39
Age: 57 (48; 65) y
Male: 77%
Mild therapeutic hypothermia by surface or invasive cooling in 25 winter and 24 summer patients.
TT: <34 °C (NR).
ED IRTT, Ototemp LighTouch; Exergen, USA; only at admission. Bladder, or esophageal None TTy at hospital admission was significantly lower (p=0.001) in winter (34.9 °C (34; 35.6)) vs. summer group (36 °C (35.3–36.3)). Core T at admission was 35.3 °C (34.8; 35.9) in winter vs. 36.2 °C (35.5–36.7) in summer group (p = 0.001).
Takeda et al. [53] CA
(mainly OHCA)
Intervention:
N: 53
Age: 72 (62; 81) y
Male: 47%
Control:
N: 55
Age: 72 (64; 78) y
Male: 67%
Intervention:
pre- or post-ROSC pharyngeal cooling plus whole body cooling.
TT: 32 °C (tympanic).
Control: standard care.
ED Thermistor thermometer, TM400, Covidien, Japan; TTy measured bilaterally, insulation with adhesive wrapping material. Rectal, or bladder None In intervention TTy showed a drop of 0.06 °C/min in the first 10 min after arrival, followed by a slower decrease. TTy was significantly lower in intervention vs. control at 40 min (33.7 ± 1.4 °C vs. 34.1 ± 1.1 °C, p = 0.02) and 120 min (32.9 ± 1.2 °C vs. 34.1 ± 1.3 °C, p < 0.001). Core T dropped by 0.02 °C/min at 30 min after arrival. Core T was significantly lower in intervention vs. control at 120 min (34.5 ± 1.1 °C vs. 35.3 ± 1.0 °C, p = 0.02).
Wandaller et al. [54] CA Intervention 1:
N: 5
Intervention 2:
N: 6
Control: none.
Demographic data: NR.
Intervention:
post-ROSC head cooling without (1) or with neck cooling (2). Additional endovascular cooling if necessary.
TT: 33 °C (esophageal).
ED Thermocouple thermometer, Mon-a-term, Mallinckrodt, Inc, USA. Esophageal and jugular None TTy showed a drop of 3.4 °C in the first 3 h of cooling. T drop was 3.7 °C at the jugular site and 2.4 °C at the esophageal site.
With respect to esophageal T, TTy displayed a bias of − 1.65 {−2.2; −1.1} °C (p=0.001) in Intervention 1 vs. −3.06 {-4.27; −1.85} °C in Intervention 2 (p=0.001).
Zeiner et al. [55] OHCA N: 27
Age: 58 (52; 64) y
Male: 74%
Post-ROSC surface body cooling
plus head and body cooling by pre-cooled
mattress.
TT: 33 ± 1 °C (pulmonary artery).
ED/ICU IRTT, Ototemp LighTouch, Exergen, USA; only at admission. Esophageal,
bladder, or pulmonary artery
None TTy was measured only at admission and showed a value of 35.3 °C (34.9–36.0 °C). NR
Ko et al. [56] OHCA Intervention:
N: 23
Age: 55 ± 15 y
Male: 87%
Control:
N: 35
Age: 63 ± 18 y
Male: 71%
Intervention:
post-ROSC whole body cooling by blanket and cold crystalloid intravenous infusion.
TT: 33 °C (tympanic).
Control:
standard care.
ED/ ICU Non-contact thermometer, NR. None None TTy detected significant differences (p = 0.004) during TTM in intervention (35.16 °C) vs. control (36.5 °C). NR
Skulec et al. [57] OHCA Intervention:
N: 40
Age: 61 ± 18 y
Male: 85%
Control:
N: 40
Age: 61 ± 17 y
Male: 72%
Intervention:
post-ROSC, PH cooling by intravenous cold saline infusion plus in-hospital TTM.
TT: <34 °C (tympanic).
Control:
standard care (in-hospital TTM).
PH/ ED NR None None In intervention, TTy dropped by 1.4 ± 0.8 °C (from 36.2 ± 1.5 to 34.7 ± 1.4 °C; p<0.001) in 42.8 ± 19.6 min. The tympanic TT was reached in 17.5% of patients. NR
Storm et al. [58] OHCA Intervention:
N: 20
Age: 62 (52; 71) y
Male: 65%
Control:
N: 25
Age: 58 (44; 66) y
Male: 84%
Intervention:
post-ROSC head cooling by hypothermia cap.
TT: NR.
Control:
standard care.
PH NR None None In intervention:
TTy dropped from 35.5 °C (34.8; 36.3) to 34.4 °C (33.6; 35.4) after head cooling (p<0.001). In two patients, TTy was not affected by cooling.
NR
Erlinge et al. [59] STEMI Intervention:
N: 61
Age: 57 (37; 79) y
Male: 79%
Control:
N: 59
Age: 59 (30; 75) y
Male: 86%
Intervention:
pre-reperfusion cooling by cold saline infusion.
TT: ≤35 °C (cooling catheter) before reperfusion.
Control: standard care.
CL NR None Cooling catheter sensor, during endovascular cooling In the intervention group, TTy was measured only at baseline and was 36.0 ± 0.7 °C. The cooling catheter T at reperfusion was 34.7 ± 0.6 °C (p=NR).
Testori et al. [60] STEMI Intervention:
N: 47
Age: 58 ± 10 y
Male: 79%
Control:
N: 54
Age: 55 ± 12 y
Male: 81%
Intervention:
PH cooling by cold saline and surface pads, followed by CL endovascular cooling.
TT: 34 °C (cooling catheter).
Control:
standard care.
PH / CL IRTT, Ototemp Ligh-Touch, Exergen, USA None Cooling catheter sensor, during endovascular cooling In the intervention group, TTy displayed a significant decrease from a baseline of 36.1 ± 0.5 °C to 35.5 ± 0.6 °C after PH cooling (p < 0.01). The cooling catheter T at reperfusion was 34.4 °C ± 0.6 °C.
  1. Data are numbers (N), percentages (%), mean, mean ± standard deviation or limits of agreements*, mean {95% confidence interval}, median§, median (interquartile range), median [range], as available. $, bias definition reversed with respect to the original publication. CA, cardiac arrest; CL, catheter lab; ED, emergency department; ICU, intensive care unit; IRTT, infrared tympanic thermometer; NR, not reported; NS, not significant; OHCA, out of hospital cardiac arrest; MI, myocardial infarction; PH, pre-hospital; r, correlation coefficient; ROSC, return of spontaneous circulation; STEMI, ST-elevation myocardial infarction; T, temperature; TM, temperature measurement; TT, target temperature; TTy, tympanic temperature; y, years; vs., versus