Some patients with COVID have abnormally high carbon dioxide and low oxygen levels despite being on the ventilator. The hypothesis of the study is that the application of mild hypothermia to patients with COVID will decrease their metabolic rate and improve their oxygenation and carbon dioxide levels.
A significant contributor to the morbidity and mortality from COVID-19 is from the abnormal
carbon dioxide and oxygen levels in COVID-19 patients. Metabolic studies done on COVID-19
patients have shown that these patients have abnormally high metabolic rates. High metabolic
rates results in increased carbon dioxide production and increased oxygen usage, both of
which can result in high carbon dioxide and low oxygen levels. As some patients with severe
COVID-19 continue to have high carbon dioxide levels and/or low oxygen levels despite being
on the ventilator, it is hypothesized that decreasing the metabolic rate in these COVID-19
patients will help their oxygen and carbon dioxide levels. Mild hypothermia is currently used
in comatose survivors of cardiac arrest to improve mortality and neurological outcomes. Mild
hypothermia is also an effective way to reduce metabolic demand. The aim is to apply mild
hypothermia to COVID-19 patients to decrease metabolic rate in order to improve their oxygen
and carbon dioxide levels. Although the application for mild hypothermia has been widely
adopted in some patient populations, it has never been applied in COVID-19 patients. If we
can develop a strategy to help improve the oxygen and carbon dioxide levels in COVID-19
patients, it may lead to improvements in their overall outcomes.
Other: Hypothermia Via Cooling Machine- Arctic Sun 5000
Initiate hypothermia using the Arctic Sun.The Arctic Sun 5000® is set to a temperature of 34.5 C to lower the body temperature.
Duration of hypothermia will be 48 hours after which the subject will be rewarmed. Metabolic rate, or indirect Calorimetry, will be assessed at baseline, day 1 of hypothermia, day 2 of hypothermia before rewarming, and after full rewarming. CBC, basic metabolic profile, magnesium, phosphorus, coagulation profile, ABG, inflammatory markers would be drawn every 12 hours during hypothermia until subject has achieved full rewarming and once after full rewarming.
The entire hypothermia procedure will last 48 hours. Acceptable rewarming range is a temperature of 36.5C to 37.5C. The subject body temperature rewarming is typically set over 6-8 hours. Therefore, the final 6-8 hours of the 48 hour time period is set to rewarm the subject.
Inclusion Criteria:
1. Provision of signed and dated informed consent form from Legally Authorized
Representative.
2. Stated willingness to comply with all study procedures and availability for the
duration of the study
3. Male or female, aged 18 years or above
4. COVID positive
5. On mechanical ventilation with either: refractory respiratory acidosis (ph ≤ 7.20),
hypercarbia (pCO2 ≥ 55 mmHg), refractory hypoxia (pO2/FIO2 <150), or plateau pressures
>30
Exclusion Criteria:
1. Bleeding (active bleeding, platelets less than 50,000)
2. Uncontrolled cardiac arrhythmia
3. History of cryoglobulinemia, major trauma, pregnancy
4. Active non-COVID-19 infection that is not controlled with antibiotic or antifungal
regimen
North Shore University Hospital
Manhasset, New York, United States