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Objectives: Recently, a novel cooling pad was developed for rapid induction of mild hypothermia after cardiac arrest. The aim of this study was to evaluate the cooling efficacy of three different pad designs for in-hospital cooling. Methods: Included in this prospective interventional study were patients with esophageal temperature (Tes) > 34°C on admission. The cooling pad consists of multiple cooling units, filled with a combination of graphite and water, which is precooled to –18°C (design A) or to –9°C (designs B and C) before use. The designs of the cooling pad differed in number, shape, and thickness of the cooling units, with weights of 9.7 kg (design A), 5.3 kg (design B), and 6.2 kg (design C). All three designs were tested in sequential order and were changed according to the results found in the previous trial. Cooling was started after admission until Tes = 34°C, when the cooling pad was removed. The target temperature of Tes = 32–34°C was maintained for 24 hours. Data are presented as medians and interquartile ranges (IQRs = 25%–75%) or proportions. Results: Cooling rates were 3.4°C/hour (IQR = 2.5–3.7) with design A ( n = 12), 2.8°C/hour (IQR = 1.6–3.3) with design B ( n = 7), and 2.9°C/hour (IQR = 1.9–3.6) with design C ( n = 10; p = 0.5). To reach 34°C, the cooling pad had to be exchanged with a new one due to melting and therefore depleting cooling capacity in three patients with design A, in five patients with design B, and in no patient with design C (p = 0.004). Conclusions: With adequate design and storage temperature, the cooling pad proved to be efficient for rapid in-hospital cooling of patients resuscitated from cardiac arrest. ACADEMIC EMERGENCY MEDICINE 2010; 17:360–367 © 2010 by the Society for Academic Emergency Medicine [ABSTRACT FROM AUTHOR]

Background: Long-term monitoring of patients at risk of arrhythmias would benefit from a miniaturized device. This study evaluated the quality of electrocardiogram (ECG) signals recorded by a miniaturized ECG recorder. Methods: ECG data were concurrently recorded with an investigational device (Philips Medical Systems, Seattle, WA, USA) and a Holter recorder from patients with cardiac-related symptoms at the emergency department of a tertiary care university hospital. The device was attached in one of four locations (L1: below left clavicle, L2: midsternal, L3: below left breast, L4: left anterior axillary line in 5th intercostal space). Selected ECG strips were analyzed for atrial activity, QRS width, and basic rhythm by two physicians. Patients were divided into groups based on their number of strips (A 2–5, B 6–9, C 10–21) for descriptive presentation of the data. For statistical analyses, nonlinear mixed-effects models were used. Results: In 90 patients, 574 pairs of strips were analyzed. In L1 (n = 37), agreement between the device and the Holter recorder on presence of P wave was 58–80% in groups A–C and in L2 (n = 28):94–98%, L3 (n = 12):30–72%, and L4 (n = 13):0–70%; on PR interval in L1:58–80%, L2:94–98%, L3:30–62%, and L4:0–70%; on rhythm in L1:56–79%, L2:94–98%, L3:30–62%, and L4:0–70%; on QRS width in L1:86–100%, L2:88–98%, L3:100%, and L4:96–100%. The agreement of L2 in the parameters P wave, PR interval, and rhythm diagnosis was better than in the other locations (P < 0.01). Conclusions: A miniature ECG monitor provided accurate assessment of atrial beats and rhythm diagnosis at a midsternal location and of QRS width at all locations. [ABSTRACT FROM AUTHOR]