• Antoine Goury, Florent Poirson, Ulriikka Chaput, Sebastian Voicu, Pierre Garçon, Thomas Beeken, Isabelle Malissin, Lamia Kerdjana, Jonathan Chelly, Dominique Vodovar, Haikel Oueslati, Jean Michel Ekherian, Philippe Marteau, Eric Vicaut, Bruno Megarbane, and Nicolas Deye.
• Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France.
• Resuscitation. 2017 Dec 1; 121: 54-61.

BackgroundTargeted temperature management (TTM) between 32 and 36°C is recommended after out-of-hospital cardiac arrest (OHCA). We aimed to assess the feasibility and safety of the "Esophageal Cooling Device" (ECD) in performing TTM.Patients And MethodsThis single-centre, prospective, interventional study included 17 comatose OHCA patients. Main exclusion criteria were: delay between OHCA and return of spontaneous circulation (ROSC)>60min, delay between sustained ROSC and inclusion >360min, known oesophageal disease. A TTM between 32 and 34°C was performed using the ECD (Advanced Cooling Therapy, USA) connected to a heat exchanger console (Meditherm III®, Gaymar, France), without cold fluids' use. Primary endpoint was feasibility of inducing, maintaining TTM, and rewarming using the ECD alone. Secondary endpoints were adverse events, focusing on potential digestive damages. Results were expressed as median (interquartiles 25-75).ResultsCooling rate to reach the Target Temperature (33°C-TT) was 0.26°C/h [0.19-0.36]. All patients reached the 32-34°C range with a time spent within the range of 26h [21-28] (3 patients did not reach 33°C). Temperature deviation outside the TT during TTM-maintenance was 0.10°C [0.03-0.20]. Time with deviation >1°C was 0h. Rewarming rate was 0.20°C/h [0.18-0.22]. Among the 16 gastrointestinal endoscopy procedures performed, 10 (62.5%) were normal. Minor oeso-gastric injuries (37.5% and 19%, respectively) were similar to usual orogastric tube injuries. One patient experienced severe oesophagitis mimicking peptic lesions, not cooling-related. No patient among the 9 alive at 3-month follow-up had gastrointestinal complains.ConclusionECD seems an interesting, safe, accurate, semi-invasive cooling method in OHCA patients treated with 33°C-TTM, particularly during the maintenance phase.Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

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