1. Thoracic heat exchange

    I enjoyed the important and educational case report submitted by Dr. Little, and congratulate him on a successful outcome using aggressive resuscitation techniques. One additional option to transfer heat efficiently to the patient's core is via a device recently introduced that allows warming through the esophagus using a closed-system silicone tube connected to standard water blanket heat exchanger.[1] This approach has been shown to provide sufficient heat to patients to avoid hypothermia in the operating room during challenging burn cases that are prone to substantial heat loss.[2] As such, esophageal warming may allow avoidance of a more invasive thoracotomy in some patients, although in the extreme case described, it is likely that adding esophageal rewarming using this modality would instead be supplementary to the thoracotomy.

    1. Kulstad E, Metzger AK, Courtney DM, Rees J, Shanley P, Matsuura T, McKnite S, Lurie K: Induction, maintenance, and reversal of therapeutic hypothermia with an esophageal heat transfer device. Resuscitation 2013, 84(11):1619-1624. 2. Williams D, Leslie G, Kyriazis D, O'Donovan B, Bowes J, Dingley J. Use of an esophageal heat exchanger to maintain core temperature during burn excisions and to attenuate pyrexia on the burns intensive care unit. Case Rep Anesthesiol. 2016;2016:6.

    Conflict of Interest:

    Co-inventor of a device, and equity holder in Attune Medical developing device mentioned in response.

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