Rapid Cooling of Body and/or Brain by Irrigating with a Cooling Liquid

Abstract

Methods and devices are disclosed for providing therapeutic hypothermia using irrigation of the aerodigestive tract with cooled liquids. The disclosed method provides much more rapid therapeutic cooling to lower temperatures than could previously be achieved, thereby improving clinical outcomes. Novel cooling liquids and cooling devices are disclosed for carrying out the method. An external turbulent flow of cooling liquid may also be applied to the exterior of the head to further promote heat exchange. Multiple embodiments of devices are disclosed for performing rapid induction and maintenance of therapeutic hypothermia either in a hospital setting or in the field so that hypothermic treatment can be quickly instituted before significant tissue damage occurs. Methods are also disclosed for targeting brain cooling by irrigating the upper airway/aerodigestive tract, and more generalized cooling by irrigating the esophagus and/or stomach.

1 . An organ hypothermia method, comprising:
 introducing a free flowing cold biologically compatible irrigation liquid from a reservoir, the reservoir comprising a container sized to receive a head of a subject such that the subject's head is at least partially immersed in the liquid in the reservoir, into the upper airway and at least a portion of the esophagus of the subject, with the irrigation liquid substantially filling and directly contacting the walls of the upper airway and the at least a portion of the esophagus, wherein the irrigation liquid comprises a temperature of −30° C. to 20° C.   
     
     
         2 . The method of  claim 1 , wherein the irrigation liquid is introduced at a first flow rate during an induction stage, the method further comprising reducing the flow rate to a second flow rate during a maintenance or rewarming stage. 
     
     
         3 . The method of  claim 1 , wherein a flow of liquid is externally applied to the head of the subject by directing a flow of the irrigation liquid toward the head of the subject from a liquid flow tube. 
     
     
         4 . The method of  claim 1 , wherein introducing the irrigation liquid into the at least a portion of the esophagus comprises placing at least one catheter in the esophagus to deliver the irrigation liquid to the at least a portion of the esophagus. 
     
     
         5 . The method of  claim 4 , wherein introducing the irrigation liquid into the at least a portion of the esophagus comprises introducing the irrigation liquid to a point substantially in the middle section of the esophagus of the subject. 
     
     
         6 . The method of  claim 4 , wherein introducing the irrigation liquid into the at least a portion of the esophagus comprises introducing the irrigation liquid into the lower esophagus of the subject. 
     
     
         7 . The method of  claim 4 , wherein introducing the irrigation liquid into the at least a portion of the esophagus comprises introducing the irrigation liquid into substantially the entire esophagus of the subject. 
     
     
         8 . The method of  claim 4 , further comprising introducing the irrigation liquid into the stomach of the subject. 
     
     
         9 . The method of  claim 8 , wherein introducing the irrigation liquid into the stomach comprises placing at least one catheter in the stomach to deliver the irrigation liquid to the stomach. 
     
     
         10 . A method for selective and non-invasive cooling of the brain, comprising:
 placing a head of a subject in a container having a reservoir of cool liquid such that the cool liquid covers the mouth and nose of the subject to provide a continuous path of liquid between the reservoir and the upper airway of the subject, and introducing a free flowing cool liquid into the upper airway and at least a portion of the esophagus of the subject, wherein the cool liquid substantially fills the upper airway, circulates within the upper airway and the at least a portion of the esophagus, and flows out of the upper airway into the reservoir of liquid in the container, thereby internally cooling the brain; while inhibiting entry of the cool liquid into the lungs.   
     
     
         11 . The method of  claim 10 , further comprising cooling the liquid by circulating the liquid through a heat exchanger. 
     
     
         12 . The method of  claim 11 , wherein circulating the liquid through a heat exchanger comprises pumping the liquid from the container to a heat exchanger external to the container, then pumping the liquid back to the container and into the upper airway of the subject. 
     
     
         13 . The method of  claim 10 , wherein inhibiting entry of the cool liquid into the lungs comprises inserting an endotracheal tube into the subject. 
     
     
         14 . The method of  claim 13 , wherein the endotracheal tube comprises an inflatable cuff, and the cuff is inflated to inhibit entry of cool liquid into the lungs. 
     
     
         15 . The method of  claim 10 , wherein introducing the flow of cool liquid into the upper airway of the subject further comprises introducing an esophageal liquid introduction catheter into the esophagus of the subject, inflating an esophageal cuff on the esophageal liquid introduction catheter to inhibit flow of cool liquid into the stomach, and pumping the cool liquid into the esophagus through a port in the esophageal liquid introduction catheter that is proximal to the esophageal cuff. 
     
     
         16 . The method of  claim 13 , wherein the cool liquid comprises a temperature of less than +10° C. 
     
     
         17 . A device for cooling the brain and washing the aerodigestive tract of a subject, comprising:
 a reservoir of cooling liquid, the reservoir being adapted for receiving and maintaining at least a portion of a head of a subject such that the subject's head is at least partially submerged in the cooling liquid;   a first liquid delivery catheter operatively connected to the reservoir and configured for insertion into a nasal cavity of the subject for delivery of the cooling liquid into the nasal cavity, and a second liquid delivery catheter operatively connected to the reservoir and configured for insertion into an oral cavity of the subject for delivery of the cooling liquid to the oral cavity of the subject;   at least one liquid circulation tube operatively connected to the reservoir;   at least one pump for circulating the cooling liquid into the at least one liquid circulation tube and into the first and second liquid delivery catheters; and   a filter to remove microbes from the cooling liquid that is discharged from the aerodigestive tract.   
     
     
         18 . The device of  claim 17 , wherein the cooling liquid comprises a water-based solution with 0.45-5% by weight of sodium chloride. 
     
     
         19 . The device of  claim 17 , wherein the cooling liquid comprises a water-based solution with 0.45-5% by weight of sodium bicarbonate. 
     
     
         20 . The device of  claim 17 , wherein the cooling liquid comprises a water-based solution with 5-25% by weight of at least one of propylene glycol, dextrose, glucose, and sucrose.