TrueCool vs CritiCool: Modular Covers Against a Full-Body Wrap

Two surface cooling systems can be built on the same principle and still commit a hospital to very different working practices. TrueCool, manufactured by EM-MED, and CritiCool, manufactured by Belmont Medical Technologies, both circulate temperature-controlled water to covers applied to the patient, and both regulate automatically from the patient's own measured temperature. What separates them is the shape of what goes on the patient — and everything that follows from that choice.

This comparison is written for intensive care, cardiology, neonatal and emergency teams, and for the biomedical engineering and procurement staff involved in the same purchase.

Scope. The comparison covers method, workflow and lifecycle. It does not present either device as clinically superior, does not reproduce technical specifications, and does not replace the manufacturers' instructions for use. Functional claims should be confirmed against the current documentation for the market you are buying in.

Shared ground: non-invasive, closed-loop surface cooling

Neither system requires vascular access. Both belong to the surface family, transferring heat through the skin, and both run in closed loop from the patient's temperature: Belmont describes CritiCool's algorithm as bringing the water to the target temperature and circulating it while reading the patient's core temperature continuously; EM-MED describes TrueCool's algorithm as managing water temperature in the covers on the basis of the patient's core temperature.

That common feature carries most of the clinical weight in this category. A network meta-analysis of 14 trials and 4,062 resuscitated patients found no significant difference in neurological outcome or survival between intravascular cooling and surface cooling with temperature feedback, while surface cooling without feedback performed worse than intravascular cooling on both endpoints (Ramadanov et al., Critical Care Medicine, 2022). Both systems described here are feedback-controlled, so the comparison between them is a comparison of engineering and workflow, not of clinical class.

Both are also used across the full arc of therapy rather than for induction alone. Current guidance for comatose patients after cardiac arrest describes continuous core temperature monitoring and active prevention of fever above 37.7 °C for at least 72 hours, following the shift away from a mandatory 33 °C target after the TTM2 trial (Sandroni et al., Intensive Care Medicine, 2022; Dankiewicz et al., New England Journal of Medicine, 2021).

The core difference: a wrap or a set of covers

CritiCool is built around the CureWrap, a single-use, body-shaped garment that is wrapped around the patient and secured. Belmont states that the adult wrap covers up to around 80% of body surface area, and that the infant version used with CritiCool MINI covers up to around 85%. High coverage is the design's central argument.

TrueCool is built around pads and blankets applied to the body regions the therapy requires, supplied by EM-MED in both disposable and reusable versions. Coverage is assembled rather than fixed, and the team can leave a region uncovered where the patient's condition requires it.

Coverage is one of two levers on the same result. A surface system can reach and hold a target either by putting more skin in contact or by working harder across the skin it is in contact with, and manufacturers weight those two differently. That is a design choice rather than a measure of capability, and published evidence has not established that one weighting produces better patient outcomes than the other.

What the choice does change is what happens at the bedside. A full-body garment has to fit: wraps are supplied in sizes, and the size range stocked determines which patients can be treated at all, which is a stock-holding decision as much as a clinical one. It also has to go on whole — where the patient has an open abdomen, a large wound, drains, an intra-aortic balloon pump site, or requires repeated skin inspection, a wrap cannot be partially applied without losing the coverage that justifies it. Modular covers reverse that profile: they are arranged around the site, and they adapt to a patient who does not match a standard body shape.

Published comparison of surface cooling systems supports the general principle that coverage and contact quality trade against each other. In a study of eight healthy adults, adhesive pads covering around 45% of body surface area produced a greater early fall in core temperature than non-adhesive blankets covering around 75%, because of quilting and loose fit — but the difference narrowed over a two-hour cooling period, and the authors noted that non-adhesive covers are easier to apply, allow access to injuries, and cost less (Leclerc et al., Therapeutic Hypothermia and Temperature Management, 2023). Neither TrueCool nor CritiCool was among the systems tested; the study is cited for what it shows about cover design as a category.

Consumables: what the wrap commits you to

The CureWrap is single-patient use. Every treated patient consumes one wrap in the correct size, and the wrap is proprietary to the system. That gives a clean, predictable cost model with no reprocessing to validate — and it fixes the running cost of the device for its service life, at whatever the manufacturer sets.

TrueCool's covers exist in disposable and reusable versions, which leaves the running cost model with the hospital. A department with established reprocessing capacity and a modest annual case volume can build a very different five-year cost profile from one that prefers single-use throughout.

Neither model is cheaper in the abstract. Ask both manufacturers for a five-year running-cost projection based on your own case volume and your own size mix, not on the console price. In this category, the console is rarely where the money goes over a decade.

Neonatal use deserves a separate answer

If cooling for hypoxic-ischaemic encephalopathy in newborns is a real use case for your unit, treat it as a distinct evaluation rather than a footnote to the adult purchase.

The clinical target is well defined. The American Academy of Pediatrics states that therapeutic hypothermia to 33.5–34.5 °C, initiated within six hours of birth and continued for 72 hours, reduces the risk of death or moderate-to-severe neurodevelopmental impairment in neonates born at 36 0/7 weeks of gestation or later with moderate-to-severe HIE (Zanelli et al., Pediatrics, 2026). Holding a target that narrow, in a patient that small, for three days is a demanding requirement for any control system, and it is why servo-controlled devices rather than manual methods are the norm in this setting.

Belmont publishes a dedicated neonatal configuration: CritiCool MINI, a compact battery-capable unit used with an infant CureWrap, positioned for neonatal and transport situations. EM-MED publishes newborns with hypoxic-ischaemic encephalopathy among TrueCool's indications.

Because cover sizing, battery operation and transport capability are decisive in this setting and differ between configurations, put the neonatal requirement to both manufacturers explicitly: which cover sizes are available, what the smallest treatable patient is, and whether the unit is intended for use during transfer.

Protocol handling and monitoring

CritiCool reads patient core temperature continuously and adjusts automatically to hold the physician-set target through the therapy.

TrueCool runs in automatic and manual modes, and its higher configuration stores complete therapy protocols that carry the patient from cooling through to scheduled controlled rewarming, so the rewarming increment is programmed rather than adjusted by hand. That configuration also monitors more than one temperature site simultaneously and records patient temperature data for the record; the simpler configuration monitors a single core site.

The rewarming phase is worth more attention than it usually receives in an evaluation. It is slow, it crosses handovers, and it is the phase in which a manually managed setting is most likely to drift. Whichever system is chosen, the question to put to the supplier is not whether it can rewarm, but how the schedule is defined, who can change it, and what the device does once rewarming ends and the remaining fever-avoidance window still has to be covered.

Product details for the system described here are published by EM-MED on its therapeutic hypothermia product page.

Where CritiCool is likely the better fit

A dedicated compact neonatal configuration with battery operation and transport use is required.

Where TrueCool is likely the better fit

Patients frequently have wounds, surgical fields, drains or access sites that a full-body garment would obstruct.
The hospital wants the option of reusable covers, keeping the running-cost model a local decision.
Stored full-therapy protocols with scheduled controlled rewarming, and simultaneous monitoring of more than one temperature site, are required.
Recording and exporting patient temperature data matters for documentation or audit.

Questions worth asking before either system is chosen

What cover sizes are stocked, and what proportion of our patient population do they fit?
Can the covers be applied to a patient with an open surgical field, drains or extensive wounds?
What is the consumable cost per patient at our real annual case volume and size mix, over five years?
Are reusable covers available, and what reprocessing protocol does the manufacturer specify?
How many temperature sites can be monitored at once, and does that match our written protocol?
Can a full therapy be stored and recalled, including a scheduled rewarming rate?
If neonates are in scope: what is the smallest treatable patient, and is the unit intended for transport?
Who services the device in our country, with what response time and what annual cost?

Frequently asked questions

Does higher body surface coverage make CritiCool the faster system?

Not on its own. Coverage is one of two levers a surface system has, the other being how hard it works across the skin it is in contact with, and manufacturers weight them differently. Speed of induction also depends on contact quality, patient factors and shivering management, and published evidence has not established that any one commercially available closed-loop surface system produces better patient outcomes than another.

What happens if the patient cannot be fully wrapped?

This is the practical limit of a garment-based system. Where a surgical field, wound or access site must remain exposed, a modular system of pads and blankets can be arranged around it, while a full-body wrap cannot be partially applied without losing the coverage that justifies it.

Are both systems suitable for cooling newborns with HIE?

Belmont publishes a dedicated compact neonatal configuration, and EM-MED lists newborns with hypoxic-ischaemic encephalopathy among TrueCool's published indications. Because cover sizing and transport capability differ between configurations, neonatal suitability should be confirmed directly with each manufacturer for the specific model and market.

Can either system be used for warming as well as cooling?

Yes. Both are used across cooling, controlled rewarming and active warming; TrueCool is described by its manufacturer as a hypo/hyperthermia unit.

How long is a temperature control device typically in use on one patient?

Longer than the cooling phase alone. Current guidance for comatose patients after cardiac arrest describes active fever prevention for at least 72 hours, and neonatal hypothermia protocols run for 72 hours followed by controlled rewarming. Evaluate a system on how it holds a target for days, not 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

Zanelli SA, Wusthoff CJ, Lucke AM, Kaufman DA. Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy: Clinical Report. Pediatrics. 2026;157(2):e2025073627. doi:10.1542/peds.2025-073627