Feasibility of a Miniature Esophageal Heat Exchange Device for Rapid Therapeutic Cooling in Newborns: Preliminary Investigations in a Piglet Model

作者：Dingley John^*; Okano Satomi; Planas Silvia; Chakkarapani Elavazhagan

来源：Therapeutic Hypothermia and Temperature Management, 2018, 8(1): 36-44.

DOI：10.1089/ther.2017.0028

• therapeutic hypothermia
• neonatal encephalopathy
• esophageal cooling

Therapeutic hypothermia (TH) after neonatal encephalopathy, commonly provided by 72 hours of whole-body cooling using a wrap, limits parents' physical contact with their infants affecting bonding and may not be suitable for encephalopathic preterm infants with fragile skin. Alternative cooling methods are unavailable for this population. We investigated in a neonatal pig model the feasibility of achieving a 3.5 degrees C reduction in rectal temperature (T-rectal) similar to clinical TH protocols from 38.5 degrees C (normothermia for pigs) to a target of 35 degrees C +/- 0.2 degrees C, using a novel neonatal esophageal heat exchanger (NEHE), compared its efficacy to passive cooling, and investigated its ability to maintain target T-rectal. Ventilated and anesthetized Landrace/Large white newborn pigs had the NEHE inserted. Water at adjustable temperatures and rates flowed down a central tube, returning up a surrounding distensible blind ending latex tube in a continuous loop. An initial experiment guided four subsequent cycles of passive cooling (30 minutes), rewarming to 38.5 degrees C, active esophageal cooling to 35 degrees C +/- 0.2 degrees C, active maintenance of target T-rectal (30 minutes), and rewarming. We compared surface, rectal temperature, and hemodynamic changes among passive, active, and maintenance phases, and esophageal histopathology against control. Compared with passive cooling, esophageal cooling achieved target T-rectal significantly earlier (71.3 minutes vs. 17.25 minutes, p = 0.003) with significantly greater rates of reduction in rectal (p = 0.0002) and surface (p = 0.005) temperatures and heart rate (p = 0.04). A water temperature of 39.1 degrees C-40.2 degrees C at a flow of 108-120 mL/min maintained T-rectal around 35 degrees C +/- 0.2 degrees C. The higher peak heart rate and blood pressure within 8 minutes of the maintenance phase (p = 0.04) subsequently stabilized. Histopathology showed congestion, edema, and neutrophil infiltration with increasing cycles. Esophageal cooling is feasible and effective in achieving rapid cooling in newborns. Subsequent maintenance at this temperature required continued circulation of warm water. Esophageal histopathology needs further evaluation after 72 hours servo-control cooling with a narrower range of water temperatures in a larger group of animals.

• 出版日期2018-3