IntraVascular Temperature

Management (IVTM)

Steffen Stegherr,
Marketing Director Circulation EMEA/LATAM
Indications
for use

IVTM
Indications for use
• Post-resuscitation Care
• Hypothermic Temperature Control
• Normothermic Temperature Control } earlier known as TTM

• Neurogenic Fever
• ICB/SAH/TBI for ICP control
• Drug-restistent fever
• Accidental hypothermia
• Prophylactic normothermia in Burn patients
• Perioperative prophylactic normothermia in surgical patients
• COVID-19 fever

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Thermogard
XP

The System
Thermogard XP System
• 2001 First generation introduction in
Europe: Coolgard
• Early adopters:
• University Hospital Heidelberg
(Germany)
• University Hospital Innsbruck
(Austria)
• Erasmus Hospital Rotterdam
(Netherlands)
• 2009 Thermogard XP introduction
• Heat exchanger significantly
improved for
• Better performance
• More precision
• Catheter portfolio broadened
• Today: >2.000 Thermogard XP
systems in place throughout Europe

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Thermogard XP – How does it work

• Cooling engine controls

temperature in cooling bath
inside device
• Patient temperature
continuously monitored by
device
• Closed feedback loop to
adjust/control temperature at a
precision of ± 0.1oC

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 Heat
Exchange
Catheters
Heat exchange catheters
IVTM catheters feature:
• Triple-lumen central venous catheter
(CVC) functions, including medication
delivery, blood draw, and central venous
pressure monitoring
• Catheter kits, which include accessories
needed for placement
• Hydrophilic coating with heparin
• Radiopaque body, tip, and marker band to
ensure proper placement in the vessel
• All IVTM catheters are MRI-compatible

Insertion sites:
• Internal jugular (IJ)
• Subclavian (S)
• Femoral (F)

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Heat Exchange Catheters
Cooling & Warming From the Inside Out
• Increased cooling & warming efficiency
• Less shivering
Precise Control
• 96.8% of time in range*
• Rapid time-to-target temperature
Simple to Use
• Reduced nursing time
• Automated intuitive system. Adjusts temperature automatically based on
patient and system information
Designed with Patient in Mind
• Unhindered patient access
• No skin issues

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 Different Phases during Hypothermic Temperature Control

Induction Rewarming
Max rate 3-4oC/hr Controlled rate
0.1-0.5oC/h

Maintenance Fever Prevention

Controlled rate Fever mode
Range ±0.1oC <37.5oC

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Clinical Data

Cardiac Arrest
Clinical data (Cardiac Arrest)

Early data from Vienna

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Clinical data (Cardiac Arrest)

Early data from Nijmegen(2007)

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Clinical data (Cardiac Arrest)

Early data from Zabre (2010)

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Clinical data (Cardiac Arrest)

COOL ARREST (USA)

• The ZOLL IVTM system was effective at
inducing TTM (median time to target
temperature from initiation, 89 minutes)

COOL ARREST (JP)

• The target temperature of 34oC was
reached by 45 minutes
• The cooling rate from 36.4oC to 33.0oC was
2.7oC/h (2.4–3.6oC/h).

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Clinical data (Cardiac Arrest)
Cooling methods - Systematic review
and meta-analysis

DOI: 10.1097/CCM.0000000000005463

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Post-resuscitation Care TTM protocol
YES Patient able to follow verbal NO
commands?
Standard Care Post-resuscitation Care incl.
incl. Imaging and PTCA Temperature Control

ABCDE Approach incl.

Monitoring+BGA

Heat Exchange Catheter

Placement in ER, Cath Lab
or ICU
• for vasopressor support
• for TTM

Online rCAST Score for Illness

severity prediction

Low Illness Mod-high Illness

severity severity
 36°C for 24hr  33°C for 24 hr

Controlled Rewarming @ 0.1-0.25°C/hr

Fever Prevention
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Post-resuscitation Care Registry Data

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Clinical Data

Neuro
Clinical data (Neuro)

Early data from Washington (2004)

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Clinical data (Neuro)

Early data from Innsbruck (2009)

“These results clearly demonstrate that an
endovascular cooling approach is significantly
superior to antipyretic treatment with anti-
inflammatory drugs in combination with
conventional surface cooling.”

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THANK YOU

© 2021 ZOLL Medical Corporation

All rights reserved.

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Backup Slides

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Antipyretics
Hemodynamic and antipyretic effects of paracetamol, metamizol and
dexketoprofen in critical patients
Vera et al. Med Intensiva 2011

• Prospective, observational study on 150 febrile patients

• 50 received paracetamol, 50 metamizol, 50 dexketoprofen
• After 3 hours a temperature decrease of at least 1 degree was
observed
• In 76% of the dexketoprofen group (=24% non-responder)
• In 72% of the metamizol group (= 28% non-responder)
• In 40% of the paracetamol group (= 60% non-responder)
• MAP was also reduced
• By 8.5 ± 13.6 mmHg with paracetamol
• By 14.9 ± 11.8 mmHg with metamizol
• By 16.8 ± 13.7 mmHg with dexketoprofen
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Antipyretic effects on temperature and hemodynamics

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Antipyretics or device for fever prevention?
Prophylactic, endovascularly based, long-term normothermia in ICU
patients with severe cerebrovascular disease: bicenter prospective,
randomized trial
Broessner et al. Stroke 2009
• Prospective randomized trial to compare prophylactic, catheter-
based normothermia (36.5 degrees) and conventional, stepwise fever
management with anti-inflammatory drugs and surface cooling
• 102 patients
• Overall fever burden in the catheter group 0.0oC hour
• Overall fever burden in the conventional group 4.3oC hours
• Conclusion:
• “Long-term, catheter-based, prophylactic normothermia
significantly reduces fever burden in neurointensive care unit
patients with severe cerebrovascular disease and is not associated
with increased major adverse events.”
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Nursing intensity
• Throughout the study period, the
boxplots for the control group were
spread farther apart.
• This indicates more variability in the
percentage of time needed for
temperature management beginning
on day 3, which is consistent with
typical fever management in neuro-
ICU patients.
• In contrast, the boxplots for CoolGard
patients required a consistently low
percentage of nursing time for
temperature management
throughout the study period.

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