Top

Published in:

01-02-2014 | Take Notice Technology

Safety Evaluation of Nasopharyngeal Cooling (RhinoChill^®) in Stroke Patients: An Observational Study

Authors: Sven Poli, Jan Purrucker, Miriam Priglinger, Marek Sykora, Jennifer Diedler, André Rupp, Cem Bulut, Werner Hacke, Christian Hametner

Published in: Neurocritical Care | Issue 1/2014

Abstract

Introduction

New technologies for therapeutic cooling have become available. The objective of our study was to investigate the safety of nasopharyngeal cooling with the RhinoChill^® device in stroke patients, focusing on systemic and neurovital parameters.

Methods

In this prospective observational study, consecutive patients with severe ischemic or hemorrhagic stroke who underwent intracranial pressure (ICP) and brain temperature monitoring have been enrolled. Ten patients who were treated with the RhinoChill^® device were analyzed. Brain and bladder temperature and systemic and neurovital parameters were monitored continuously. Additional evaluations of safety included bleeding complications and otolaryngological examinations.

Results

Baseline brain temperature of 36.7 °C (SD 0.9) decreased by an average of 1.21 °C (SD 0.46) within 1 h, the effect of brain temperature decrease ranged from a maximum of 2 °C (patients 3 and 7) to a minimum of 0.6 °C (patient 4). Within the first several minutes after initiating RhinoChill^® treatment, 3 of 10 patients experienced an increase in systolic arterial pressure by 30, 30, and 53 mmHg, respectively. Heart rate rose as well (mean 3 bpm, SD 2.9). ICP and oxygen saturation were unaffected by the treatment. We observed 1 bleeding complication in the control CT scan of patient 10. Rhinoscopical findings 3 days after nasopharyngeal cooling and at the follow-up (>6 months) and a 16-item smell test were normal.

Conclusion

The RhinoChill^® system cools the brain efficiently. However, steep increases in blood pressure raise serious concerns regarding the safety of its use in stroke patients.

Blanco M, Campos F, Rodriguez-Yanez M, et al. Neuroprotection or increased brain damage mediated by temperature in stroke is time dependent. PLoS ONE. 2012;7:e30700.PubMedCentralPubMedCrossRef

Xue D, Huang ZG, Smith KE, Buchan AM. Immediate or delayed mild hypothermia prevents focal cerebral infarction. Brain Res. 1992;587:66–72.PubMedCrossRef

Kammersgaard LP, Jorgensen HS, Rungby JA, et al. Admission body temperature predicts long-term mortality after acute stroke: the Copenhagen Stroke Study. Stroke. 2002;33:1759–62.PubMedCrossRef

Reith J, Jorgensen HS, Pedersen PM, et al. Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome. Lancet. 1996;347:422–5.PubMedCrossRef

Wang Y, Lim LL, Levi C, Heller RF, Fisher J. Influence of admission body temperature on stroke mortality. Stroke. 2000;31:404–9.PubMedCrossRef

Holzer M. Devices for rapid induction of hypothermia. Eur J Anaesthesiol Suppl. 2008;42:31–8.PubMedCrossRef

Castren M, Nordberg P, Svensson L, et al. Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Circulation. 2010;122:729–36.PubMedCrossRef

Abou-Chebl A, Sung G, Barbut D, Torbey M. Local brain temperature reduction through intranasal cooling with the RhinoChill device: preliminary safety data in brain-injured patients. Stroke. 2011;42:2164–9.PubMedCrossRef

Schwab S, Schwarz S, Spranger M, Keller E, Bertram M, Hacke W. Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke. 1998;29:2461–6.PubMedCrossRef

10.

Busch HJ, Eichwede F, Fodisch M, et al. Safety and feasibility of nasopharyngeal evaporative cooling in the emergency department setting in survivors of cardiac arrest. Resuscitation. 2010;81:943–9.PubMedCrossRef

11.

Wolfson MR, Malone DJ, Wu J, et al. Intranasal perfluorochemical spray for preferential brain cooling in sheep. Neurocrit Care. 2008;8:437–47.PubMedCrossRef

12.

Yu T, Barbut D, Ristagno G, et al. Survival and neurological outcomes after nasopharyngeal cooling or peripheral vein cold saline infusion initiated during cardiopulmonary resuscitation in a porcine model of prolonged cardiac arrest. Crit Care Med. 2010;38:916–21.PubMedCrossRef

13.

Dodd DE, Brashear WT, Vinegar A. Metabolism and pharmacokinetics of selected halon replacement candidates. Toxicol Lett. 1993;68:37–47.PubMedCrossRef

14.

Doering LV. The effect of positioning on hemodynamics and gas exchange in the critically ill: a review. Am j crit care. 1993;2:208–16.PubMed

15.

Ledwith MB, Bloom S, Maloney-Wilensky E, Coyle B, Polomano RC, Le Roux PD. Effect of body position on cerebral oxygenation and physiologic parameters in patients with acute neurological conditions. J neurosci nurs. 2010;42:280–7.PubMedCrossRef

16.

Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation. 2007;116:e391–413.PubMedCrossRef

17.

European Stroke Initiative Writing C, Writing Committee for the EEC, Steiner T, et al. Recommendations for the management of intracranial haemorrhage—part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee. Cerebrovasc dis. 2006;22:294–316.

18.

Daum RF, Sekinger B, Kobal G, Lang CJ. Olfactory testing with “sniffin’ sticks” for clinical diagnosis of Parkinson disease. Der Nervenarzt. 2000;71:643–50.PubMedCrossRef

19.

Lyden P, Ernstrom K, Cruz-Flores S, et al. Determinants of effective cooling during endovascular hypothermia. Neurocrit Care. 2012;16:413–20.PubMedCentralPubMedCrossRef

20.

Mellergard P. Changes in human intracerebral temperature in response to different methods of brain cooling. Neurosurgery. 1992;31:671–7 discussion 7.PubMedCrossRef

21.

Springborg JB, Springborg KK, Romner B. First clinical experience with intranasal cooling for hyperthermia in brain-injured patients. Neurocrit care. 2013;18(3):400–5.PubMedCrossRef

22.

Andrews PJ, Harris B, Murray GD. Randomized controlled trial of effects of the airflow through the upper respiratory tract of intubated brain-injured patients on brain temperature and selective brain cooling. Br J Anaesth. 2005;94:330–5.PubMedCrossRef

23.

Akata T, Setoguchi H, Shirozu K, Yoshino J. Reliability of temperatures measured at standard monitoring sites as an index of brain temperature during deep hypothermic cardiopulmonary bypass conducted for thoracic aortic reconstruction. J thorac cardiovasc surg. 2007;133:1559–65.PubMedCrossRef

24.

Simon E. Tympanic temperature is not suited to indicate selective brain cooling in humans: a re-evaluation of the thermophysiological basics. Eur J Appl Physiol. 2007;101:19–30.PubMedCrossRef

25.

Mitsuma W, Ito M, Kodama M, et al. Clinical and cardiac features of patients with subarachnoid haemorrhage presenting with out-of-hospital cardiac arrest. Resuscitation. 2011;82:1294–7.PubMedCrossRef

26.

Skrifvars MB, Parr MJ. Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature. Scand j trauma resusc emerg med. 2012;20:75.PubMedCentralPubMedCrossRef

Title: Safety Evaluation of Nasopharyngeal Cooling (RhinoChill®) in Stroke Patients: An Observational Study
Authors: Sven Poli
Jan Purrucker
Miriam Priglinger
Marek Sykora
Jennifer Diedler
André Rupp
Cem Bulut
Werner Hacke
Christian Hametner
Publication date: 01-02-2014
Publisher: Springer US
Published in: Neurocritical Care / Issue 1/2014
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-013-9904-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Safety Evaluation of Nasopharyngeal Cooling (RhinoChill^®) in Stroke Patients: An Observational Study

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2014

Recognizing 2013 Manuscript Reviewers

Systematic Review of Efficacy, Pharmacokinetics, and Administration of Intraventricular Vancomycin in Adults

Sensitivity of Compressed Spectral Arrays for Detecting Seizures in Acutely Ill Adults

Cerebral Blood Flow and Transcranial Doppler Sonography Measurements of CO2-Reactivity in Acute Traumatic Brain Injured Patients

Comparison of Non-invasive and Invasive Arterial Blood Pressure Measurement for Assessment of Dynamic Cerebral Autoregulation

Red Blood Cell Transfusion Increases the Risk of Thrombotic Events in Patients with Subarachnoid Hemorrhage