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THE PHYSICIAN AND SPORTSMEDICINE - VOL 31 - NO. 8 - AUGUST 2021


Heat Illness Prevention Goes High Tech

New Devices Enter Sports Medicine Market

A recent rash of heat-related deaths among high-profile athletes has focused efforts on preventing heat illness. Two new portable cooling devices may help physicians and athletic trainers minimize the effects of heat, not only to safeguard player health but also to boost athletic performance.

One device—rapid thermal exchange (RTX) (figure 1)—is designed to cool the body from within by draining heat from the palm of the hand. Another device, Game Ready, provides portable, external cooling and compression (figure 2). Though neither device is intended to treat collapsed athletes, they may represent new tools for preventing heat illness.

Device Profiles

RTX. This device (AVAcore Technologies, Inc, Palo Alto, California), also known as "the Glove," was specifically designed to lower core body temperature by drawing heat away from arteriovenous anastomoses in the palms of the hands. When an athlete places a hand in the RTX device, cooling and a slight vacuum effect speed the transfer of body heat to the environment.

RTX was developed over the last decade by two Stanford University researchers whose specialty is mammalian thermoregulation. Julian Nikolchev, president and chief executive officer of AVAcore, says the technology behind the device represents a direct leap from animal research to clinical practice for humans. "Most mammals have heat portals; they don't sweat," Nikolchev says. "On a stressful, hot day they have efficient mechanisms for dissipating heat." The tongues and paws of many mammals have anteriovenous anastomoses that, similar to radiators, transfer heat. Human equivalents include the anastomoses in the palms of the hands.

The device has been tested on the sidelines of elite sports teams and will be available commercially this fall. RTX is expected to cost about $3,000. Tim Wilson, CSCS, strength and conditioning coach of the Milwaukee Bucks, says he read about RTX in the lay press, so when the Bucks were in the basketball playoffs this spring, he contacted AVAcore and asked if the team could try RTX, even though the device was still at the prototype stage. "We're always looking for a performance edge," Wilson says. Though he says the theory behind the device sounds compelling, he says the team really didn't have an opportunity to thoroughly evaluate RTX's usefulness.

Game Ready. The Game Ready system (CoolSystems, Inc, Berkeley, California), developed by a scientist whose focus is thermal control and space suit technology, is primarily used to automate icing and compression for musculoskeletal injuries. It (figure 2) consists of a small motorized unit and various attachments that allow treatment of the wrist, elbow, shoulder, back, knee, and ankle. The system also includes a hooded vest that allows body cooling for heat illness prevention. The hood-vest attachment is being investigated as a means of helping multiple sclerosis patients avoid overheating during exercise.

The Game Ready system has been on the market since summer 2021. CPT codes are available for traditional cooling and compression uses. The base unit costs about $2,000, and site-specific wraps each cost between $200 and $700. Jim McCrossin, CSCS, ATC, athletic trainer and strength and conditioning coach for the Philadelphia Flyers, obtained a Game Ready system for his team in January. He says he hasn't had the opportunity to use the hooded vest yet, but he has had good results using the system to treat musculoskeletal injuries. He says portability is the device's biggest advantage; similar mechanized cold-compression treatments are typically only available in, for example, a physical therapist's office. "We can do treatments on the plane or at the rink," McCrossin says. "It's an adjunct to all the other modalities that we use."

Initial Field Reports

Steven Erickson, MD, team physician for Arizona State University, works in an environment in which using cooling modalities is vital. He says the Game Ready devices are used in the training room to treat musculoskeletal injuries. "Last year we purchased the cooling vest, but we have not had the opportunity to use it yet," he says. Though Erickson is open to considering new advances in cooling technology, he says that as a physician who has treated heat illness at ultraendurance events, he's more of a traditionalist. "I still feel that ice packs to the groin and axilla or submersion in an ice bath are probably the most effective means of cooling someone, especially on the field when you may or may not have a device like Game Ready," he says.

Erickson notes that he observed RTX only once when ASU hosted Stanford last fall in a rare daytime game. Thus far, Erickson is skeptical about its efficacy and wonders if its main effect is to change athletes' perceptions of how hot they are rather than actually reducing the core body temperature.

Meanwhile, Charles Miller, ATC, head athletic trainer for the Stanford football team, has had more extensive experience with RTX because the device was developed on campus. He encouraged a few players to try the device during two-a-day practices. "They said they felt better during the second half of practice," he says.

The team took two RTX units with them when they played Boston College last season, Miller says. He noticed an unintended effect: dramatic recoveries among players who had muscle cramping. Though he says he still uses traditional methods such as prehydration and rehydration to prevent cramping, he says the role of body heat in cramping should be investigated further.

Lisa Schnirring
Minneapolis


Field Notes

AEDs Safe for Children

New guidelines published in the July 1 issue of Circulation state that automated external defibrillators (AEDs) are safe for use in children ages 1 to 8 who have no signs of circulation. Data have shown that the devices are effective in younger children, and AEDs specifically designed for children have been approved by the US Food and Drug Administration. Though the newer devices reduce the adult level of shock, standard models have been shown to benefit children.

The guidelines, issued by the American Heart Association and several other medical groups, advise first giving 1 minute of standard cardiopulmonary resuscitation to children 1 to 8 before attempting to revive them with an AED. They recommend that child-sized cables and pads be used whenever possible and that each specific AED model be tested against a library of pediatric arrhythmias to document its ability to detect shockable and nonshockable rhythms.

Sports Scientist Fights for Heavyweight Title

Vitali Klitschko, PhD, a Ukrainian boxer who holds a doctoral degree in sports science from a German university, recently lost a title match on June 21 in Los Angeles to Lennox Lewis. According to a report on the Pravda Web site, Klitschko, also known as Dr Iron Fist, was ahead in the sixth round when the referee stopped the match because of a severe cut above the fighter's left eye. The referee declared a technical knockout based on the advice of the ringside physician.


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