Esophageal Oxygen Monitoring with Gastric Suction

[Rialaigh]

Looking for some products and finding limited information online. We are getting serious about our hypothermia program and have ground transports when the chopper doesn't fly in excess of an hour to an hour and a half to a suitable facility. Looking for core temperature monitoring capability preferably with gastric suction.

Looking for any monitoring options out there at this point.

 

[jwk]

Don't know about one with suction capability, but esophageal temp probes are readily available and used every day by anesthesia in surgery. The same probe can be used rectally as well if you so desire.

 

[triemal04]

I don't think there are any that combine suction with temperature monitoring; don't know why as it easy enough to place an esophageal temp probe and then an OG/NG tube along side it.

There are lot's out there; it might depend on what monitor you have, but I'm pretty sure that most current ones have the same type of adapter, so just check with whatever company you buy your equipment from; boundtree or otherwise.

I know the LP15 can do that, and I think the new Zoll can as well.

If you don't have a monitor with that capability there are also stand alone thermometers that'll work fine; again, check with the company you use.

 

[Smash]

Seems odd to be getting serious about prehospital therapeutic hypothermia when it has pretty conclusively been shown not to help.

 

[unleashedfury]

Looking for some products and finding limited information online. We are getting serious about our hypothermia program and have ground transports when the chopper doesn't fly in excess of an hour to an hour and a half to a suitable facility. Looking for core temperature monitoring capability preferably with gastric suction.

Looking for any monitoring options out there at this point.

IIRC The LP15 offers an accessory to provide temperature monitoring via various routes..

so RTFM..... Look at Page 4-61 - 4-65 It even offers the troubleshooting chart.

 

[blindsideflank]

Seems odd to be getting serious about prehospital therapeutic hypothermia when it has pretty conclusively been shown not to help.

Hmm... I know of the recent large study that came out regarding in hospital hypothermic therapy but there are other studies supporting it. As for out of hospital I can't recall any solid studies on the subject.

The fact still remains that EVERY patient we resuscitate in the field is hypothermic upon arrival at the hospital, regardless of cooling iv fluids and ice packs.

 

[NomadicMedic]

Hmm... I know of the recent large study that came out regarding in hospital hypothermic therapy but there are other studies supporting it. As for out of hospital I can't recall any solid studies on the subject.

The fact still remains that EVERY patient we resuscitate in the field is hypothermic upon arrival at the hospital, regardless of cooling iv fluids and ice packs.

You're aware of the difference between "therapeutic hypothermia" and the fact that patients may be hypothermic due to exposure?

 

[Smash]

Hmm... I know of the recent large study that came out regarding in hospital hypothermic therapy but there are other studies supporting it. As for out of hospital I can't recall any solid studies on the subject.

The fact still remains that EVERY patient we resuscitate in the field is hypothermic upon arrival at the hospital, regardless of cooling iv fluids and ice packs.

There are solid studies in the prehospital realm, none of which have ever showed any benefit to starting cooling early. The first decent, intention to treat, randomized trial into prehospital TH was Stephen Bernard's RICH trial, which in itself actually showed no benefit to prehospital cooling anyway. The only reason it was continued was at the time therapeutic hypothermia was thought to be beneficial, so there was no harm done and it prompted ERs to continue treatment.

However, since then the TTM trial was published in NEJM, which was larger and more pragmatic than any previous studies, in hospital or out. It showed no benefit over a temperature of 33C versus 36C. Of course this is slightly different to older studies in which fever was left alone, and we are fairly sure that fever is bad for broken brains. However as you have noticed, it is highly unlikely that you are going to see fever in the post-arrest patient in the field. It is something that typically occurs in the days following ICU admission.

The same month JAMA published the Seattle prehospital trial which (like Bernard's trial) also showed no benefit.

So there are very good trials into pre-hospital and in-hospital cooling and the evidence we now have that therapeutic hypothermia conveys no benefit far outweighs any evidence for it's utility. We would all like it to work in what we have always seen as a bit of a hopeless situation (a bit like tPA for stroke), but sadly it doesn't (a bit like tPA for stroke). Given this, it would seem odd to put time and money into starting up a prehospital TH program at this stage. Concentrate on the management of perfusion and ventilation and don't worry about the temperature too much.

 

[Handsome Robb]

What monitor do you use? We use the Philips MRx continuous esophageal/rectal temp probe and it's freaking awesome.

I think it's interesting how TH got real big and as soon as it's used widely in EMS it comes out that it has no benefit.

 

[triemal04]

Hmm... I know of the recent large study that came out regarding in hospital hypothermic therapy but there are other studies supporting it. As for out of hospital I can't recall any solid studies on the subject.

The fact still remains that EVERY patient we resuscitate in the field is hypothermic upon arrival at the hospital, regardless of cooling iv fluids and ice packs.

Actually...not so much, and for the ones that are it'll be very minimal. Granted, this could differ depending on the part of the country and season.

If you look at the supplements for the hypothermia trial published in JAMA, the average temp of patients who DID NOT recieve cold saline was about 36C, or just barely under that. Really not that cold at all.

If you (anyone) can get access to the full study, including the supplemental data, it's actually really interesting reading, as a lot of info unrelated to hypothermia can be found and extrapolated from it.

 

[VFlutter]

What monitor do you use? We use the Philips MRx continuous esophageal/rectal temp probe and it's freaking awesome.

I think it's interesting how TH got real big and as soon as it's used widely in EMS it comes out that it has no benefit.

I am waiting for a good study of TH for acute stroke.

 

[Smash]

I am waiting for a good study of TH for acute stroke.

I'm waiting for a good study of tPA for acute stroke

 

[Smash]

I think it's interesting how TH got real big and as soon as it's used widely in EMS it comes out that it has no benefit.

It's actually a really good example of evidence based medicine in action. Prior to the TTM and Seattle trials, the best evidence we had was that TH was good for patients. However the studies weren't really all that good (lots of animal studies) and the prehospital ones (Bernard et al in particular) already showed no benefit in starting TH in the field.
Then, following the bigger, better trials being published, we realised we were wrong and things changed, to the point where Steve Bernard himself has changed his practice in his ICU.
Looking at the power calculations and statistical jiggery pokery of the TTM trial (I am told, not being a mathemagician myself) there is still room for some further study (such as intra-arrest rather than post-arrest cooling) however the best evidence we now have is that TH is not helpful.
And of course it has NEVER been shown to be helpful in the field.