TrueCool vs Arctic Sun 5000: How the Two Surface Cooling Systems Compare

Clinicians and hospital procurement teams rarely choose a temperature management system in the abstract. The question is usually narrower: we already know we need targeted temperature management (TTM), so which system fits our unit, our protocol and our budget over the next decade?

This comparison looks at two surface cooling systems used for that purpose — TrueCool, manufactured by EM-MED, and Arctic Sun 5000, manufactured by BD. It is written for intensive care, cardiology and emergency teams, and for the biomedical and purchasing staff who sit in the same meetings.

A note on what this comparison does and does not do. It compares the two systems at the level of method, workflow and lifecycle — how each one transfers heat, what it needs from the staff around it, and what it commits the hospital to over time. It does not present either device as clinically superior to the other, does not reproduce technical specifications, and is not a substitute for the manufacturers’ instructions for use. Any purchasing decision should be made against your own protocols, your notified specification and the current documentation for the market you are buying in.

Both are surface systems — and that shared ground matters

Temperature management after cardiac arrest is delivered by two device families. Intravascular systems exchange heat with the blood through a catheter placed in a central vein. Surface systems transfer heat through the skin, using pads, blankets or wraps supplied with circulating water from a control unit.

TrueCool and Arctic Sun 5000 both belong to the second family. Neither requires vascular access, and both regulate automatically from the patient’s own measured temperature rather than from a fixed water setting. That closed-loop behaviour is not a marketing detail — it is the part of the design that the clinical evidence actually rewards.

A network meta-analysis of 14 trials covering 4,062 resuscitated patients separated three approaches: intravascular cooling, surface cooling with temperature feedback, and surface cooling without feedback. It found no significant difference in neurological outcome or survival between intravascular cooling and feedback-guided surface cooling, while surface cooling without feedback performed worse than intravascular cooling on both endpoints (Ramadanov et al., Critical Care Medicine, 2022).

The practical reading is straightforward. The meaningful dividing line in this category runs between systems that close the loop on patient temperature and systems that do not — not between one closed-loop brand and another. Both devices discussed here sit on the right side of that line, so the comparison has to be made on other grounds.

For completeness: a post hoc analysis of the TTM2 trial reported that intravascular cooling reached target temperature within four hours more often than surface cooling and produced fewer out-of-range temperature measurements, although six-month survival and functional outcome did not differ significantly between the two (Awad et al., Intensive Care Medicine, 2025). That comparison is between device families, not between the two systems described here.

The patient interface is the real difference

The console is not what your staff will spend the therapy interacting with. The patient interface is.

Arctic Sun 5000 uses ArcticGel pads: a hydrogel-coated adhesive layer that bonds to the skin, a middle layer carrying circulating water, and an insulating outer layer. BD states the pads are single-patient use, that the water circuit runs under negative pressure to limit spillage if a pad is pierced, and that the pads are defibrillator-safe and compatible with imaging environments including MRI, CT, X-ray and the cath lab. The adhesive bond is the design’s core idea — constant, tight skin contact for the whole therapy.

TrueCool uses pads and blankets supplied with circulating water from the control unit, with the water temperature set by the unit itself, continuously, from the patient’s own core temperature. EM-MED publishes that the covers are available in both disposable and reusable versions. The interface is modular rather than a single bonded system: you place what the patient’s condition allows, and you can get to the skin, to wounds and to lines without breaking an adhesive bond.

Neither approach is free. A study in eight healthy adults compared surface systems over two hours of cooling and found that adhesive hydrogel pads covering around 45% of body surface area produced a greater early fall in core temperature than non-adhesive whole-body blankets covering around 75%, because the non-adhesive covers showed quilting and loose fit. The same study found the early advantage diminished over the course of cooling, and noted that non-adhesive systems are easier to apply, allow access to injuries, and cost less (Leclerc et al., Therapeutic Hypothermia and Temperature Management, 2023). TrueCool was not among the systems tested; the study is cited here for what it shows about adhesive and non-adhesive interfaces as design choices, not as a test of any device in this comparison.

Consumables, reprocessing and the cost that repeats

This is where a ten-year view separates the two systems more clearly than any clinical argument.

Arctic Sun 5000 is built around a single-patient-use consumable. Every patient treated is a pad order, and the pads are proprietary. That model is predictable and clean — there is no reprocessing question, no cleaning protocol to validate, and no argument about how many uses a cover has left. It also means the running cost of the system is fixed by the manufacturer for the life of the device.

TrueCool’s covers exist in disposable and reusable versions, which shifts the decision back to the hospital. A unit that treats a small number of TTM patients a year and has established reprocessing capacity can run a very different cost profile from one that treats many and prefers single-use throughout. Neither is universally cheaper; the point is that the choice stays open.

Ask both manufacturers for a five-year running-cost model based on your own case volume, not on a list price for the console. In this category the console is rarely where the money goes.

Protocol handling, monitoring and the rewarming phase

Temperature control is not a single act. Guidelines describe an extended commitment: in comatose patients after cardiac arrest, continuous monitoring of core temperature and active prevention of fever — defined as a temperature above 37.7 °C — for at least 72 hours (Sandroni et al., Intensive Care Medicine, 2022). Since the TTM2 trial, the emphasis in the guidelines has moved away from a mandatory 33 °C target and towards actively controlled temperature with fever avoidance, which in practice means a device is attached to the patient for longer, not for less time (Dankiewicz et al., New England Journal of Medicine, 2021).

That is why the controlled rewarming phase, and the days after it, deserve as much attention in an evaluation as induction speed does. Rewarming too quickly undoes part of what the therapy was for, and it is the phase where a system’s ability to move in fine, scheduled increments is tested.

TrueCool runs in both automatic and manual modes, carries preset full-therapy protocols that include the controlled rewarming phase, and in its higher configuration monitors more than one temperature site simultaneously and records patient temperature data for the record. In automatic mode the unit does not treat every patient the same way. After each cooling or rewarming cycle it reads how sharply that patient’s core temperature actually moved, and tempers what it does next accordingly — easing off where the temperature is already falling quickly, working harder where it is barely shifting. The result is that the patient settles at the set target instead of overshooting it, which matters because two patients on the same programme can respond very differently. Arctic Sun 5000 regulates in closed loop from patient temperature across induction, maintenance and rewarming. For either system, the question to put to the supplier is not whether it can rewarm, but how the rewarming schedule is set, who can change it, and what happens at the end of it.

Where Arctic Sun 5000 is likely the better fit

• Imaging or defibrillation with pads left in place is a hard requirement — BD publishes compatibility, and it should be confirmed against the current instructions for use.

Where TrueCool is likely the better fit

• The hospital wants the option of reusable covers alongside disposables, and wants running cost to remain a local decision.
• Simultaneous monitoring of more than one temperature site is wanted during maintenance and rewarming.
• Preset full-therapy protocols, including scheduled controlled rewarming, are valued over a purely manual approach.
• The buyer wants a direct line to a European manufacturer and a named distributor, rather than a support path through a large multinational’s regional structure.

Full product information for the targeted temperature management system described here is published by EM-MED on the TrueCool product page.

Questions worth asking before either system is chosen

1. What is the total consumable cost per patient, at our real annual case volume, over five years?
2. Are covers available in reusable form, and if so, what reprocessing protocol does the manufacturer specify?
3. How many temperature sites can the system monitor at once, and which sites does our protocol require?
4. How is the controlled rewarming rate set, and can a full protocol be stored and reused?
5. What does the system do after rewarming ends, when fever avoidance still has to run for the rest of the 72-hour window?
6. Can the covers stay in place for imaging or defibrillation, and is that documented in the current instructions for use?
7. What is the service response time in our country, and who performs it — the manufacturer, the distributor, or a third party?
8. Is patient temperature data recorded and exportable, and in what form?

Frequently asked questions

Is Arctic Sun 5000 or TrueCool better for cooling after cardiac arrest?

Neither can be presented as clinically superior on the basis of published evidence. Both are surface systems that regulate from the patient’s own temperature, and the evidence to date separates feedback-controlled cooling from non-feedback cooling rather than one feedback-controlled brand from another. The choice is normally made on interface design, consumable model, monitoring capability and local support.

What is the practical difference between adhesive hydrogel pads and circulating-water pads and blankets?

Adhesive pads bond to the skin and hold constant contact, which favours heat transfer but ties the therapy to a proprietary single-use consumable and makes skin and wound access less immediate. Circulating-water pads and blankets are placed rather than bonded, which allows access to the patient and, in TrueCool’s case, allows reusable covers — at the cost of contact quality depending more on how the covers are applied.

Does either system also warm the patient?

Both are used across cooling, maintenance and controlled rewarming. TrueCool is described by its manufacturer as a hypo/hyperthermia unit, meaning the same control unit is used for cooling and for warming.

Are these systems suitable for indications other than cardiac arrest?

EM-MED publishes indications for TrueCool including post cardiac arrest care, ischaemic stroke, hypoxic-ischaemic encephalopathy in newborns, and febrile patients. Indications differ by device and by market, and should always be confirmed against the manufacturer’s current documentation for the country of purchase.

How long does a temperature control device stay attached to the patient?

Current guidance for comatose patients after cardiac arrest describes continuous core temperature monitoring and active fever prevention for at least 72 hours, which is considerably longer than the cooling phase alone. This is a practical argument for evaluating a system on its maintenance and post-rewarming behaviour, not only on how fast it induces.

Sources and further reading

• Dankiewicz J, Cronberg T, Lilja G, et al. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. N Engl J Med. 2021;384(24):2283–2294. doi:10.1056/NEJMoa2100591
• Sandroni C, Nolan JP, Andersen LW, et al. ERC-ESICM guidelines on temperature control after cardiac arrest in adults. Intensive Care Med. 2022;48(3):261–269. doi:10.1007/s00134-022-06620-5
• Ramadanov N, Arrich J, Klein R, Herkner H, Behringer W. Intravascular Versus Surface Cooling in Patients Resuscitated From Cardiac Arrest: A Systematic Review and Network Meta-Analysis With Focus on Temperature Feedback. Crit Care Med. 2022;50(6):999–1009. doi:10.1097/CCM.0000000000005463
• Leclerc C, Talebian nia M, Giesbrecht GG. Heat Transfer Capabilities of Surface Cooling Systems for Inducing Therapeutic Hypothermia. Ther Hypothermia Temp Manag. 2023;13(3):149–158. doi:10.1089/ther.2023.0003
• Awad A, Jonsson M, Holgersson J, et al. Intravascular vs. surface cooling in out-of-hospital cardiac arrest patients receiving hypothermia after hospital arrival: a post hoc analysis of the TTM2 trial. Intensive Care Med. 2025;51(4):721–730. doi:10.1007/s00134-025-07883-4