Overview of Therapeutic Hypothermia
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Therapeutic hypothermia has proven neuroprotective effects in global cerebral ischemia. Indications for hypothermia induction include cardiac arrest and neonatal asphyxia. The two general methods of induced hypothermia are either surface cooling or endovascular cooling. Hypothermia should be induced as early as possible to achieve maximum neuroprotection and edema blocking effect. Endovascular cooling has the benefit of shorter time to reach target temperature but catheter insertion requires expertise and training, which may be a barrier to widespread availability. The optimum method of cooling is yet to be determined but a multimodal approach is necessary to address three phases of cooling: induction, maintentance, and rewarm. Specifying core practitioners who are well-versed in established guidelines can help integrate the multidisciplinary team that is needed to successfully implement cooling protocols. Reducing shivering to make heat exchange more efficient with tighter temperature control enables quicker time to target temperature and avoids rewarming which can lead to inadvertent increase in intracranial pressure and cerebral edema. Promising applications but yet to be determined is whether hypothermia treatment can improve outcomes in acute ischemic stroke or traumatic brain injury.
KeywordsHypothermia Therapeutic hypothermia Cardiac arrest Cerebral ischemia Surface cooling Endovascular cooling Shivering Neuroprotection Treatment
Drs. Song and Lyden are investigators at Cedars-Sinai for the Intravascular Cooling in the Treatment of Stroke 2/3 Trial (ICTuS2/3). This study is part of the National Institutes of Health–sponsored, Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) program, which allows researchers to enhance and initiate translational research that ultimately will benefit stroke patients by treating more patients in less than 2 hours, and finding ways to treat additional patients later.
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