Arctic Sun medical device and Between the Hills

Contents 1 Background 2 Device description 3 See also 4 References 5 External links

Background

Body temperature, which is systematically measured and reported as a vital sign, contributes to maintenance of normal physiology and affects the processes that lead to recovery after illness. Complete and proper functioning of the body is dependent on maintaining a core temperature between 36.5–38.5 °C (97.7–101.3 °F). A core temperature above 41.5°C or below 33.5°C causes a fast decline in proper functioning of the body and may result in injury or death. Intentional manipulation of body temperature has been studied as a treatment strategy for head injuries since the 1900s. In the 1980s, the use of hypothermia on dogs after cardiac arrest demonstrated positive outcomes including neurological status and survival. In 2005, the American Heart Association implemented recommendations and guidelines for mild hypothermia in post-resuscitation support after cardiac arrest with return of spontaneous circulation.

One of the most common practices of targeted temperature management is to reduce body temperature to a “mild hypothermic state” (per the AHA guidelines is 33°C (91.4°F) for 12–24 hours and then slowly re-warm the body back to normal 37°C (98.6°F). The purpose of this is to slow the metabolic processes and the chemical cascade that occurs when the brain goes without oxygen for a period of time. A study conducted in 2002-2004 showed that treatment with therapeutic hypothermia for patients resuscitated after cardiac arrest due to ventricular fibrillation led to a positive outcome (Glasgow-Pittsburgh Cerebral Performance category 1 or 2) in 24 of 43 patients compared to only 11 of 43 patients in the standard resuscitation group where no hypothermia was used in treatment.

Therapeutic hypothermia, which lowers the patient's body temperature to levels between 32–34 °C (90–93 °F), is used to help reduce the risk of the ischemic injury to the brain following a period of insufficient blood flow. Periods of insufficient blood flow may be caused by cardiac arrest, stroke, or brain trauma. Non-invasively induced therapeutic hypothermia has been shown to reduce mortality of successfully resuscitated cardiac arrest victims by 35 percent and increase the chance of a good neurologic outcome by 39 percent. Device description

The Arctic Sun has been explained as dry water immersion. It is a non-invasive precision temperature management system that is often used to induce hypothermia in comatose patients that have suffered from Sudden Cardiac Arrest (SCA) and patients at risk for ischemic brain damage. The unique thing about the Arctic Sun is the gel pads, which stick to a patient’s body using an adhesive called hydrogel—a substance that adheres to the skin without removing hair follicles. The gel pads cover only a portion of a patient’s body and subsequently leave most of the body free for augmenting medical procedures. The device operates under negative pressure and circulates water through these pads at a temperature between 4–42 °C (39–108 °F). Water is pulled through the pads, which minimizes the risk of leakage. By controlling the temperature of the water running through the gel pads, the Arctic Sun’s adjusts a patient’s temperature. Arctic Sun can also rewarm patients. Controlled rewarming has been cited in the literature as beneficial in preventing reperfusion injury. Because of the Arctic Sun’s noninvasive nature, treatment can be delivered without the host of adverse events associated with invasive procedures such as cooling catheters.

A former complaint levied against the Arctic Sun relates to the risk of skin injury. a study published in 2007 found that the Arctic Sun was, "highly effective in lowering patients’ temperature rapidly without inducing skin irritations.". Further, when comparing MDR's registered by Medivance vs the cooling catheters and conventional cooling blankets and wraps, one will find far fewere incidence of patient injury.

Invasive cooling catheter companies have claimed that catheters can lower body temperature at a faster rate, which is relevant because most of the clinical data suggests that the sooner cooling initiates the better a patient’s outcome. However, there exists a 75 minute delay on average between admittance and catheter insertion. Even with a physician readily available to place the cooling catheter, the operating instructions underline the importance of the device set up with takes a minimum of 25 minutes. When objectively evaluating the published data the average cooling rate for cooling catheters is 1.12°C. Treatment with the Arctic Sun can be administered within 10 minutes by unsupervised nursing professionals.

Historically, clinicians reported that catheters cool at a quicker rate, however, a 2011 study published in the Society of Critical Care Medicine where 167 patients treated either with the Arctic Sun or the Alsius Coolgard Catheter showed the following:

There was no significant difference in survival with good neurologic function, either to hospital discharge or at follow-up. Time from cardiac arrest to achieving mild therapeutic hypothermia was equal with both devices (surface, 273 min, core, 270 min).” Cooling was initiated immediately in the emergency department on hospital arrival with ice packs around groin, armpits and neck and infusion of up to 3 L of refrigerated saline All patients were "deeply sedated" No device-specific patient injuries were observed; skin injuries with the Arctic Sun or DVT with Coolgard No differences in shivering: " Article quote: "Skin temperature is known to influence thermoregulatory control, and it previously has been speculated that core cooling could result in less shivering.

However, this could not be confirmed in the present study, because there was no difference in the rate of shivering in surface-cooled or core-cooled patients.” No differences were observed in Lengths of ICU stay, durations of respirator dependency, rates of MTH discontinuation, and post cooling

Conclusions: “Surface and core cooling of out-of hospital cardiac arrest patients following the same established postresuscitation treatment protocol resulted in similar survival to hospital discharge and comparable neurologic function at follow-up.”

Crit Care Med Vol 39 No 3

In a case attracting much media attention in May 2008, the Arctic Sun was used to induce hypothermia in a 59 year old woman in West Virginia who had suffered 3 cardiac arrests within a 24 hour period. For more than 17 hours the woman had no measurable brain waves, according to her doctors, and her heart had been stopped for a prolonged period of time. The family decided to take her off life support. Shortly after being disconnected from the ventilator, the woman surprisingly recovered, regaining consciousness, motor function, and speech. See also Medical equipment Resuscitation Therapeutic hypothermia

Between the Hills and Arctic Sun medical device

Contents 1 Geography 1.1 Transportation 2 Geology 3 History 4 References

Geography

The Between the Hills valley encompasses the area of Loudoun that lies west of Short Hill Mountain and east of the Blue Ridge Mountain. The area includes the communities of Neersville and Loudoun Heights.

Between the Hills can be divided into two sections; the upper and lower valley. The upper valley encompasses the area north of the Hillsboro Gap in the Short Hill, while the lower valley encompasses the area south of the gap. The valley ranges from 2.5 miles (4.0 km) wide at its largest, just south of the Hillsboro gap to 1.4 miles (2.3 km) wide at its smallest, east of Purcell Knob in the upper valley and is approximately 11 miles (18 km) long.

The main waterways of Between the Hills are the North Fork of Catoctin Creek, which drains the lower valley before flowing through the Hillsboro gap into the Catoctin Valley, and Piney Run, which drains the upper valley and flows north through the valley directly into the Potomac River.

Across the Potomac River, the valley continues as Pleasant Valley in Maryland. Transportation

State Route 671, Harpers Ferry Road, is the main road in the valley, running north-south through the upper valley from its southern terminus at Virginia State Route 9, Charles Town Pike, west of Hillsboro, to its northern terminus at U.S. Route 340, south of the Sandy Hook bridge over the Potomac River and east of Harpers Ferry. State Route 719, Stony Point-Woodgrove road runs north-south through the lower valley from Hillsboro to Woodgrove. The Charlestown pike bisects the valley, running southeast-northwest from the Hillsboro Gap to Keyes Gap in the Blue Ridge. Geology

The Between the Hills Valley was formed by action along the Short Hill fault during the early Paleozoic era, which resulted in separation of the underlying rocks of the Blue Ridge and Short Hill mountains, which were deposited during the Catoctin Formation of the late Proterozoic period and uplifted during the Grenville Orogeny. Reactivation of the fault during the Alleghenian Orogeny caused further separation of underlying rock deposited during the middle and late Paleozoic era. History

During the American Civil War, a Between the Hills resident, John Mobberly, gained notoriety as a Confederate guerrilla. During the last two years of the war, he successfully disputed control of the area through his daring exploits, until his assassination outside of Neersville in April 1865. In late November-early December 1864 much of the Between the Hills valley was put to the torch by Union cavalry during The Burning Raid, including Potts Mill, the ruins of which can be seen from off Stony Point Road. Confederate partisan John Mosby and his Rangers suffered their first defeat during the Battle of Loudoun Heights was fought on January 1, 1864, in the valley and along the eastern slopes of the Blue Ridge.
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