Preliminary evaluation of the arctic sun temperature-controlling system during off-pump coronary artery bypass surgery

doi:10.1016/S0003-4975(02)04545-9

The Annals of Thoracic Surgery

Volume 75, Issue 4, April 2003, Pages 1140-1144

https://doi.org/10.1016/S0003-4975(02)04545-9 Get rights and content

Abstract

Background

Maintaining normothermia during off-pump coronary artery bypass (OPCAB) surgery is a challenge not met by currently available medical devices and strategies. The purpose of this study was to determine the efficacy of a new thermoregulatory device, the Arctic Sun temperature-controlling circulating fluid adhesive pad system, in preventing hypothermia during OPCAB surgery.

Methods

Thirteen consenting patients undergoing OPCAB had their temperature managed using the Arctic Sun™ system. They were matched with 23 consenting control OPCAB patients whose temperature was maintained with standardized, conventional therapy (elevated ambient operating room temperature, warmed intravenous fluids, and a convective forced air warming system placed under the surgical drapes). Nasopharyngeal temperature (recorded at 1-minute intervals) was compared between the two groups by analysis of both the time and area under the curve for a temperature less than 36°C.

Results

Multivariate linear regression analysis revealed that the average amount of hypothermia in the Arctic Sun group was significantly less than in the control group, both for time spent less than 36°C (20.7 vs 121.3 minutes, p = 0.0004) and for area under the curve less than 36°C (11.8°C vs 78.1°C × minutes, p = 0.0001).

Conclusions

The Arctic Sun temperature-controlling system is more effective than conventional warming methods in preventing hypothermia during OPCAB surgery.

Section snippets

Patient selection

After Institutional Review Board approval, written informed consent was obtained from 20 patients undergoing OPCAB surgery between January and June 2000. The control group consisted of a matched group of 23 OPCAB patients with similar surgery times treated during the same period of time and who consented to participate in a concurrent epidemiological study. Because of changes to the planned surgical procedure before the operation but after patient consent, 5 patients underwent conventional

Results

The demographic characteristics of both groups are shown in Table 1. There were no significant differences between the treatment and control groups. The control group had 121.3 (31 to 205) minutes (median and interquartile range) less than 36°C, whereas the treatment group had 20.7 (0 to 24) minutes (median and interquartile range) (p = 0.0001). As shown in Figure 1, the amount of hypothermia (quantified as the temperature area < 36°C × min) was significantly greater in the control group

Comment

OPCAB surgery is becoming an increasingly popular alternative to CPB surgery. By reducing aortic manipulations and eliminating the nonphysiologic environment of CPB, OPCAB surgery has several advantages over conventional CABG. Without the heat exchanger present in the CPB circuit that assists in controlling the patient’s temperature during CPB, temperature management during OPCAB surgery has become a new challenge. There are multiple sources of heat loss in the operative environment that often

Acknowledgements

This research project was funded by an educational grant from MediVance Incorporated, Louisville, CO. The authors thank Yvonne M. Connelly, MA, MPH, for editorial assistance with the manuscript.

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There are more references available in the full text version of this article.

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Citation Excerpt :
Strategies to achieve normothermia are generally nonstandardized, passive (ie, elevated operating room temperature and warmed intravenous fluids and ventilation gases), and variably successful. Conductive warming devices have recently been introduced to improve patient warming [6]. The clinical efficacy of surface warming, however, remains in question and has not been widely embraced.
Normothermia during off-pump coronary bypass (OPCAB) grafting reduces metabolic derangements and contributes to improved clinical outcomes. Thus study examined the feasibility and efficacy of intraoperative temperature control using a novel endovascular heating system during OPCAB.
Thirty-eight consecutive patients undergoing OPCAB were prospectively randomized to receive conventional warming (elevated room temperature, warmed intravenous fluids, warming blanket) or the Thermogard system (Alsius Corp, Irvine, CA). The triple-lumen temperature control Icy catheter (Alsius Corp) was inserted percutaneously into the inferior vena cava through common femoral vein. The catheter was removed after all wounds were closed. Temperature measurements (bladder, nasopharyngeal, and blood) were recorded at 5-minute intervals and compared between groups.
Patient demographics did not significantly differ between groups. The 17 Thermogard patients warmed at a significantly faster rate than the 21 control patients (0.28° vs 0.11°C/h, p = 0.03). Furthermore, Thermogard patients received more bypass grafts (3.4 ± 0.6 vs 2.6 ± 0.9, p < 0.001) and less intraoperative fluids (1557.0 ± 547.7 vs 2012.3 ± 723.1 mL, p = 0.02) despite longer operative times (150.3 ± 123.4 vs 108.1 ± 43.7 min; p = 0.12). All catheters were placed successfully on the first attempt, and there were no device-related complications.
Endovascular warming is safe, simple to use, and obviates the need for uncomfortably warm operating room temperatures. The Thermogard system compared favorably with conventional methods for warming during OPCAB.
Hypothermia during cardiac surgery
2008, Best Practice and Research: Clinical Anaesthesiology
Citation Excerpt :
Patients warmed with the Arctic Sun system bled less postoperatively, required fewer transfusions and demonstrated better heat transfer to peripheral tissues, thereby reducing afterdrop. Furthermore, patients were extubated more quickly, stayed in the intensive care unit for a shorter time, and were discharged from hospital earlier.51,52 The Allon ThermoWrap system (MTRE Advanced Technologies Ltd, Or-Akiva, Israel) is another alternative.
This chapter describes the incidence, mechanisms and possible consequences of hypothermia during cardiac surgery, including protection against ischaemia, alteration of the coagulation cascade and the inflammatory response. Various temperature-specific topics related to cardiac surgery are discussed, including the use of hypothermia or normothermia during cardiopulmonary bypass, and the temperature reached during rewarming at the end of cardiopulmonary bypass and its deleterious consequences for the brain (postoperative neurocognitive dysfunction). Various locations for monitoring body temperature and their correlation with the central core temperature are evaluated, as is the correlation between oxygenation of the brain and oxygen extraction monitored at the jugular bulb. Modern cardiac techniques, such as off-pump surgery and minimal extracorporeal circulation, and their implications for temperature preservation are discussed. Finally, a protocol is proposed that combines mild intra-operative hypothermia with peripheral active warming in order to avoid the need for fast, intense rewarming, thus avoiding the potential incidence of brain damage.

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^*: The members of the Neurologic Outcome Research Group of the Duke Heart Center are listed in Appendix 1. The Cardiothoracic Anesthesiology Research Endeavors (C.A.R.E.) Investigators are listed in Appendix 2.

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Original article: cardiovascularPreliminary evaluation of the arctic sun temperature-controlling system during off-pump coronary artery bypass surgery

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patient selection

Results

Comment

Acknowledgements

Pharmacol Ther

Randomized trial of normothermic versus hypothermic coronary bypass surgery

Lancet

Prospective, randomized trial of retrograde warm blood cardioplegiamyocardial benefit and neurologic threat

Ann Thorac Surg

The implications of hypothermia for early tracheal extubation following cardiac surgery

J Cardiothorac Vasc Anesth

Original article: cardiovascular
Preliminary evaluation of the arctic sun temperature-controlling system during off-pump coronary artery bypass surgery