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Heating and Cooling Rates With an Esophageal Heat Exchange System

Kalasbail Prathima MD; Makarova, Natalya MSc; Garrett, Frank; Sessler, Daniel I. MD
doi: 10.1213/ANE.0000000000002691
Research Report: PDF Only


The Esophageal Cooling Device circulates warm or cool water through an esophageal heat exchanger, but warming and cooling efficacy in patients remains unknown. We therefore determined heat exchange rates during warming and cooling.


Nineteen patients completed the trial. All had general endotracheal anesthesia for nonthoracic surgery. Intraoperative heat transfer was measured during cooling (exchanger fluid at 7°C) and warming (fluid at 42°C). Each was evaluated for 30 minutes, with the initial condition determined randomly, starting at least 40 minutes after induction of anesthesia. Heat transfer rate was estimated from fluid flow through the esophageal heat exchanger and inflow and outflow temperatures. Core temperature was estimated from a zero-heat-flux thermometer positioned on the forehead.


Mean heat transfer rate during warming was 18 (95% confidence interval, 16–20) W, which increased core temperature at a rate of 0.5°C/h ± 0.6°C/h (mean ± standard deviation). During cooling, mean heat transfer rate was −53 (−59 to −48) W, which decreased core temperature at a rate of 0.9°C/h ± 0.9°C/h.


Esophageal warming transferred 18 W which is considerably less than the 80 W reported with lower or upper body forced-air covers. However, esophageal warming can be used to supplement surface warming or provide warming in cases not amenable to surface warming. Esophageal cooling transferred more than twice as much heat as warming, consequent to the much larger difference between core and circulating fluid temperature with cooling (29°C) than warming (6°C). Esophageal cooling extracts less heat than endovascular catheters but can be used to supplement catheter-based cooling or possibly replace them in appropriate patients.

Accepted for publication October 20, 2017.

Funding: This work was supported by Advanced Cooling Therapy (Chicago, IL).

Conflicts of Interest: See Disclosures at the end of the article.

Institutional review board: Cleveland Clinic Institutional Review Board, 9500 Euclid Ave, Desk OS01, Cleveland, OH 44195. E-mail:

This study was registered at

Reprints will not be available from the authors.,

Address correspondence to Daniel I. Sessler, MD, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave—P77, Cleveland, OH 44195. Address e-mail to

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