Temperature management during off-pump coronary artery bypass graft surgery: a randomized clinical trial on the efficacy of a circulating water system versus a forced-air system

OBJECTIVE: The aim of this study was to evaluate the performance of a new temperature management system specifically designed for cardiac surgery (Allon ThermoWrapping Thermoregulation System; MTRE Advanced Technologies Ltd, Or Akiva, Israel) using a circulating-water garment and to compare it with a conventional forced-air cover system in order to determine whether it could reduce the incidence of perioperative hypothermia during off-pump coronary artery bypass graft (OPCAB) surgery. DESIGN: Prospective, randomized. SETTING: University, tertiary care hospital. PARTICIPANTS: Thirty-one patients undergoing primary OPCAB surgery. INTERVENTIONS: Patients undergoing OPCAB surgery were randomized into the new thermoregulation system, Allon (study group, n = 15), and the standard forced-air system, Bair Hugger (Sterile Cardiac Access blanket Model 645; Augustine SA, Berne, Switzerland) (control group, n = 16). MEASUREMENTS AND MAIN RESULTS: Rectal temperature was recorded each 30 minutes during surgery and at intensive care unit arrival. Patients in the study group had higher temperatures than the control group at all time points, and the difference reached statistical significance after 2 hours of surgery. Moreover, fewer patients in the study group suffered perioperative hypothermia (defined as rectal temperature <36 degrees C) than the control group (2/15 patients (13.3%) in the study group v 13/16 (81.3%) in the control group [p = 0.0006]). No difference in other outcomes was noted. None of the patients died in the hospital. There were no adverse events reported. CONCLUSIONS: The circulating-water garment, Allon ThermoWrapping Thermoregulation System, maintained normothermia during OPCAB surgery better than forced-air systems, especially after the first 2 hours of surgery, and it was not associated with surgical field disturbance.