Skip to main content
SpringerLink
Log in

Therapeutische Hypothermie

Therapeutic hypothermia

  • CME Weiterbildung • Zertifizierte Fortbildung
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Nach Herz-Kreislauf-Stillstand konnte durch den Einsatz der therapeutischen Hypothermie eine Verbesserung von Überleben und neurologischem Ergebnis gezeigt werden. Auch Patienten nach Schädel-Hirn-Trauma oder ischämischem Schlaganfall könnten von der therapeutischen Hypothermie profitieren. Ihre Induktion gelingt durch verschiedene Verfahren wie die Oberflächenkühlung, kalte Infusionen oder endovaskuläre Kühlkatheter. Mögliche Nebenwirkungen umfassen insbesondere Infektionen und Blutungen sowie Veränderungen des Wasser- und Elektrolythaushalts. Ziel dieses Artikels ist es, einen Überblick über die aktuelle Studienlage zu vermitteln sowie praktische Anleitung zum Einsatz der therapeutischen Hypothermie zu geben.

Abstract

The use of therapeutic hypothermia has been shown to improve survival and neurological outcome following cardiac arrest. Patients with traumatic brain injury or ischemic stroke also responded positively to therapeutic hypothermia, which may be induced by various procedures including surface cooling, endovascular cooling catheter and cold infusion. Possible side effects include infection and hemorrhage, as well as changes in water and electrolyte levels. It is the aim of this article to provide an overview of studies to date, as well as practical guidance for the application of therapeutic hypothermia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Adrie C, Adib-Conquy M, Laurent I et al. (2002) Successful cardiopulmonary resuscitation after cardiac arrest as a „sepsis-like“ syndrome. Circulation 106: 562–568

    Article  PubMed  Google Scholar 

  2. Akriotis V, Biggar WD (1985) The effects of hypothermia on neutrophil function in vitro. J Leukoc Biol 37: 51–61

    PubMed  CAS  Google Scholar 

  3. Alderson P, Gadkary C, Signorini DF (2004) Therapeutic hypothermia for head injury. Cochrane Database Syst Rev 2004: CD001048

    Google Scholar 

  4. Althaus U, Aeberhard P, Schüpbach P et al. (1982) Management of profound accidental hypothermia with cardiorespiratory arrest. Ann Surg 195: 492–495

    Article  PubMed  CAS  Google Scholar 

  5. Arrich J, European Resuscitation Council Hypothermia After Cardiac Arrest Registry Study Group (2007) Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med 35: 1041–1047

    Article  PubMed  Google Scholar 

  6. Baud F (2006) Clinical and economical interest of endovascular cooling in the management of cardiac arrest (ICEREA study). http://clinicaltrials.gov/show/NCT00392639

  7. Berger C, Schäbitz WR, Georgiadis D et al. (2002) Effects of hypothermia on excitatory amino acids and metabolism in stroke patients: a microdialysis study. Stroke 33: 519–524

    Article  PubMed  CAS  Google Scholar 

  8. Bernard GR (2003) Drotrecogin alfa (activated) (recombinant human activated protein C) for the treatment of severe sepsis. Crit Care Med 31: S85–S93

    Article  PubMed  CAS  Google Scholar 

  9. Bernard SA, Gray TW, Buist MD et al. (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346: 557–563

    Article  PubMed  Google Scholar 

  10. Bernard S, Buist M, Monteiro O et al. (2003) Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation 56: 9–13

    Article  PubMed  Google Scholar 

  11. Bierens JJLM, Uitslager R, Swenne-van Ingen MME et al. (1995) Accidental hypothermia: incidence, risk factors and clinical course of patients admitted to hospital. Eur J Emerg Med 2: 38–46

    Article  PubMed  CAS  Google Scholar 

  12. Bock M, Müller J, Bach A et al. (1998) Effects of preinduction and intraoperative warming during major laparotomy. Br J Anaesth 80: 159–163

    PubMed  CAS  Google Scholar 

  13. Bolte RG, Black PG, Bowers RS et al. (1988) The use of extracorporeal rewarming in a child submerged for 66 minutes. JAMA 260: 377–379

    Article  PubMed  CAS  Google Scholar 

  14. Botterell EH, Lougheed WM, Scott JW et al. (1956) Hypothermia, and interruption of carotid, or carotid and vertebral circulation, in the surgical management of intracranial aneurysms. J Neurosurg 13: 1–42

    Article  PubMed  CAS  Google Scholar 

  15. Brain Trauma Foundation (2007) Guidelines for the management of severe traumatic brain injury, 3rd edn. J Neurotrauma 24: S1–S106

    Article  Google Scholar 

  16. Broman M, Källskog Ö, Nygren K et al. (1998) The role of antidiuretic hormone in cold-induced diuresis in the anaesthetized rat. Acta Physiol Scand 162: 475–480

    Article  PubMed  CAS  Google Scholar 

  17. Carroll M, Beek O (1992) Protection against hippocampal CA1 cell loss by post-ischemic hypothermia is dependent on delay of initiation and duration. Metab Brain Dis 7: 45–50

    Article  PubMed  CAS  Google Scholar 

  18. Clifton GL, Drever PG (2007) Effects of hypothermia upon outcomes after acute traumatic brain injury (NABIS:HIIR). http://clinicaltrials.gov/show/NCT00178711

  19. Clifton GL, Choi SC, Miller ER et al. (2001) Intercenter variance in clinical trials of head trauma – experience of the National Acute Brain Injury Study: hypothermia. J Neurosurg 95: 751–755

    PubMed  CAS  Google Scholar 

  20. Clifton GL, Miller ER, Choi SC et al. (2001) Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 344: 556–563

    Article  PubMed  CAS  Google Scholar 

  21. Clifton GL, Miller ER, Choi SC et al. (2002) Hypothermia on admission in patients with severe brain injury. J Neurotrauma 19: 293–301

    Article  PubMed  Google Scholar 

  22. Coimbra C, Wieloch T (1994) Moderate hypothermia mitigates neuronal damage in the rat brain when initiated several hours following transient cerebral ischemia. Acta Neuropathol 87: 325–331

    Article  PubMed  CAS  Google Scholar 

  23. Dae MW, Gao DW, Sessler DI et al. (2002) Effect of endovascular cooling on myocardial temperature, infarct size, and cardiac output in human-sized pigs. Am J Physiol Heart Circ Physiol 282: H1584–H1591

    PubMed  CAS  Google Scholar 

  24. Danzl DF, Pozos RS (1994) Accidental hypothermia. N Engl J Med 331: 1756–1760

    Article  PubMed  CAS  Google Scholar 

  25. De Georgia MA, Krieger DW, Abou-Chebl A et al. (2004) Cooling for acute ischemic brain damage (COOL AID): a feasibility trial of endovascular cooling. Neurology 63: 312–317

    Google Scholar 

  26. Edwards AD, Azzopardi DV (2006) Therapeutic hypothermia following perinatal asphyxia. Arch Dis Child Fetal Neonatal Ed 91: F127–F131

    Article  PubMed  CAS  Google Scholar 

  27. Eicher DJ, Wagner CL, Katikaneni LP et al. (2005) Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol 32: 11–17

    Article  PubMed  Google Scholar 

  28. Els T, Oehm E, Voigt S et al. (2006) Safety and therapeutical benefit of hemicraniectomy combined with mild hypothermia in comparison with hemicraniectomy alone in patients with malignant ischemic stroke. Cerebrovasc Dis 21: 79–85

    Article  PubMed  Google Scholar 

  29. European Resuscitation Council (2005) European Resuscitation Council guidelines for resuscitation 2005. Resuscitation 67: S1–S189; dtsch Notfall Rettungsmed 9: 6–170

    Google Scholar 

  30. Farstad M, Heltne JK, Rynning SE et al. (2004) Can the use of methylprednisolone, vitamin C, or α-trinositol prevent cold-induced fluid extravasation during cardiopulmonary bypass in piglets? J Thorac Cardiovasc Surg 127: 525–534

    Article  PubMed  CAS  Google Scholar 

  31. Frank SM, Fleisher LA, Breslow MJ et al. (1997) Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 277: 1127–1134

    Article  PubMed  CAS  Google Scholar 

  32. Gentilello LM, Jurkovich GJ, Stark MS et al. (1997) Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. Ann Surg 226: 439–447

    Article  PubMed  CAS  Google Scholar 

  33. Gluckman PD, Wyatt JS, Azzopardi D et al. (2005) Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 365: 663–670

    PubMed  Google Scholar 

  34. Guluma KZ, Hemmen TM, Olsen SE et al. (2006) A trial of therapeutic hypothermia via endovascular approach in awake patients with acute ischemic stroke: methodology. Acad Emerg Med 13: 820–827

    Article  PubMed  Google Scholar 

  35. Hachimi-Idrissi S, Corne L, Ebinger G et al. (2001) Mild hypothermia induced by a helmet device: a clinical feasibility study. Resuscitation 51: 275–281

    Article  PubMed  CAS  Google Scholar 

  36. Hachimi-Idrissi S, Van Hemelrijck A, Michotte A et al. (2004) Postischemic mild hypothermia reduces neurotransmitter release and astroglial cell proliferation during reperfusion after asphyxial cardiac arrest in rats. Brain Res 1019: 217–225

    Article  PubMed  CAS  Google Scholar 

  37. Hägerdal M, Harp J, Nilsson L et al. (1975) The effect of induced hypothermia upon oxygen consumption in the rat brain. J Neurochem 24: 311–316

    Article  PubMed  Google Scholar 

  38. Hajat C, Hajat S, Sharma P (2000) Effects of poststroke pyrexia on stroke outcome: a meta-analysis of studies in patients. Stroke 31: 410–414

    PubMed  CAS  Google Scholar 

  39. Harris OA, Colford JM Jr, Good MC et al. (2002) The role of hypothermia in the management of severe brain injury: a meta-analysis. Arch Neurol 59: 1077–1083

    Article  PubMed  Google Scholar 

  40. Haugk M, Sterz F, Grassberger M et al. (2007) Feasibility and efficacy of a new non-invasive surface cooling device in post-resuscitation intensive care medicine. Resuscitation 75: 76–81

    Article  PubMed  Google Scholar 

  41. Heller G, Gräsner JT, Dörges V et al. (2007) Milde Hypothermie nach Reanimation – Standardtherapie an norddeutschen Krankenhausern? Anästhesiol Intensivmed Notfallmed Schmerzther 42: 419–420

    Article  PubMed  Google Scholar 

  42. Henderson WR, Dhingra VK, Chittock DR et al. (2003) Hypothermia in the management of traumatic brain injury. A systematic review and meta-analysis. Intensive Care Med 29: 1637–1644

    Article  PubMed  Google Scholar 

  43. Holzer M, Bernard SA, Hachimi-Idrissi S et al. (2005) Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis. Crit Care Med 33: 414–418

    Article  PubMed  Google Scholar 

  44. Holzer M, Müllner M, Sterz F et al. (2006) Efficacy and safety of endovascular cooling after cardiac arrest: cohort study and Bayesian approach. Stroke 37: 1792–1797

    Article  PubMed  Google Scholar 

  45. Horiguchi T, Shimizu K, Ogino M et al. (2003) Postischemic hypothermia inhibits the generation of hydroxyl radical following transient forebrain ischemia in rats. J Neurotrauma 20: 511–520

    Article  PubMed  Google Scholar 

  46. Hypothermia after Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346: 549–556

    Article  Google Scholar 

  47. International Liaison Committee on Resuscitation (2003) Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation. Resuscitation 57: 231–235

    Article  Google Scholar 

  48. Jiang JY, Gao GY, Li WP et al. (2002) Early indicators of prognosis in 846 cases of severe traumatic brain injury. J Neurotrauma 19: 869–874

    Article  PubMed  Google Scholar 

  49. Kettner SC, Sitzwohl C, Zimpfer M et al. (2003) The effect of graded hypothermia (36°C–32°C) on hemostasis in anesthetized patients without surgical trauma. Anesth Analg 96: 1772–1776

    Article  PubMed  CAS  Google Scholar 

  50. Kim F, Olsufka M, Longstreth WT et al. (2007) Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4°C normal saline. Circulation 115: 3064–3070

    Article  PubMed  Google Scholar 

  51. Kimberger O, Ali SZ, Markstaller M et al. (2007) Meperidine and skin surface warming additively reduce the shivering threshold: a volunteer study. Crit Care 11: R29

    Article  PubMed  Google Scholar 

  52. Kranke P, Eberhart LH, Roewer N et al. (2002) Pharmacological treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg 94: 453–460

    Article  PubMed  CAS  Google Scholar 

  53. Krieger DW, De Georgia MA, Abou-Chebl A et al. (2001) Cooling for acute ischemic brain damage (COOL AID): an open pilot study of induced hypothermia in acute ischemic stroke. Stroke 32: 1847–1854

    PubMed  CAS  Google Scholar 

  54. Kuboyama K, Safar P, Radovsky A et al. (1993) Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac arrest in dogs: a prospective, randomized study. Crit Care Med 21: 1348–1358

    Article  PubMed  CAS  Google Scholar 

  55. Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 334: 1209–1215

    Article  PubMed  CAS  Google Scholar 

  56. Langhelle A, Tyvold SS, Lexow K et al. (2003) In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway. Resuscitation 56: 247–263

    Article  PubMed  CAS  Google Scholar 

  57. Lehot JJ, Piriz H, Villard J et al. (1992) Glucose homeostasis. Comparison between hypothermic and normothermic cardiopulmonary bypass. Chest 102: 106–111

    Article  PubMed  CAS  Google Scholar 

  58. Luna GK, Maier RV, Pavlin EG et al. (1987) Incidence and effect of hypothermia in seriously injured patients. J Trauma 27: 1014–1018

    PubMed  CAS  Google Scholar 

  59. Mackowiak PA, Wasserman SS, Levine MM (1992) A critical appraisal of 98.6°F, the upper limit of the normal body temperature, and other legacies of Carl Reinhold August Wunderlich. JAMA 268: 1578–1580

    Article  PubMed  CAS  Google Scholar 

  60. Maekawa T, Yamashita S (2005). Therapeutic hypothermia for severe traumatic brain injury in Japan. http://clinicaltrials.gov/show/NCT00134472

  61. Markgraf CG, Clifton GL, Moody MR (2001) Treatment window for hypothermia in brain injury. J Neurosurg 95: 979–983

    PubMed  CAS  Google Scholar 

  62. McIntyre LA, Fergusson DA, Hébert PC et al. (2003) Prolonged therapeutic hypothermia after traumatic brain injury in adults: a systematic review. JAMA 289: 2992–2999

    Article  PubMed  Google Scholar 

  63. Merchant RM, Soar J, Skrifvars MB et al. (2006) Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest. Crit Care Med 34: 1935–1940

    Article  PubMed  Google Scholar 

  64. Müllner M, Sterz F, Binder M et al. (1997) Blood glucose concentration after cardiopulmonary resuscitation influences functional neurological recovery in human cardiac arrest survivors. J Cereb Blood Flow Metab 17: 430–436

    Article  PubMed  Google Scholar 

  65. Oesterhelweg L, Klotzbach H, Püschel K (2003) Zur Epidemiologie und Phänomenologie des Kältetodes. Rechtsmedizin 13: 11–17

    Google Scholar 

  66. Padosch SA, Vogel P, Böttiger BW (2001) Neuronale Apoptose nach zerebraler Ischämie. Grundlagen, Pathophysiologie und Interventionsmöglichkeiten. Anaesthesist 50: 905–920

    Article  PubMed  CAS  Google Scholar 

  67. Polderman KH, Peerdeman SM, Girbes ARJ (2001) Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury. J Neurosurg 94: 697–705

    PubMed  CAS  Google Scholar 

  68. Polderman KH, Tjong Tjin Joe R, Peerdeman SM et al. (2002) Effects of therapeutic hypothermia on intracranial pressure and outcome in patients with severe head injury. Intensive Care Med 28: 1563–1573

    Article  PubMed  Google Scholar 

  69. Polderman KH, Ely EW, Badr AE et al. (2004) Induced hypothermia in traumatic brain injury: considering the conflicting results of meta-analyses and moving forward. Intensive Care Med 30: 1860–1864

    Article  PubMed  Google Scholar 

  70. Popp E, Sterz F, Böttiger BW (2005) Therapeutische milde Hypothermie nach Herz-Kreislauf-Stillstand. Anaesthesist 54: 96–106

    Article  PubMed  CAS  Google Scholar 

  71. Rivers E, Nguyen B, Havstad S et al. (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345: 1368–1377

    Article  PubMed  CAS  Google Scholar 

  72. Rumana CS, Gopinath SP, Uzura M et al. (1998) Brain temperature exceeds systemic temperature in head-injured patients. Crit Care Med 26: 562–567

    Article  PubMed  CAS  Google Scholar 

  73. Schmied H, Kurz A, Sessler DI et al. (1996) Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 347: 289–292

    Article  PubMed  CAS  Google Scholar 

  74. Schwab S (2005) Therapy of severe ischemic stroke: breaking the conventional thinking. Cerebrovasc Dis 20: 169–178

    Article  PubMed  Google Scholar 

  75. Schwab S, Schwarz S, Aschoff A et al. (1998) Moderate hypothermia and brain temperature in patients with severe middle cerebral artery infarction. Acta Neurochir Suppl 71: 131–134

    PubMed  CAS  Google Scholar 

  76. Schwab S, Georgiadis D, Berrouschot J et al. (2001) Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke 32: 2033–2035

    Article  PubMed  CAS  Google Scholar 

  77. Sessler DI (1997) Mild perioperative hypothermia. N Engl J Med 336: 1730–1737

    Article  PubMed  CAS  Google Scholar 

  78. Sessler DI (1998) Reviews of educational material: „Poikilothermia in man: pathophysiological aspects and clinical implications“. Anesthesiology 88: 841–842

    Article  Google Scholar 

  79. Sessler DI, Rubinstein EH, Moayeri A (1991) Physiologic responses to mild perianesthetic hypothermia in humans. Anesthesiology 75: 594–610

    Article  PubMed  CAS  Google Scholar 

  80. Shankaran S, Laptook AR, Ehrenkranz RA et al. (2005) Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 353: 1574–1584

    Article  PubMed  CAS  Google Scholar 

  81. Spahn DR, Cerny V, Coats TJ et al. (2007) Management of bleeding following major trauma: a European guideline. Crit Care 11: R17

    Article  PubMed  Google Scholar 

  82. Steinberg GK, Ogilvy CS, Shuer LM et al. (2004) Comparison of endovascular and surface cooling during unruptured cerebral aneurysm repair. Neurosurgery 55: 307–314

    Article  PubMed  Google Scholar 

  83. Sundgreen C, Larsen FS, Herzog TM et al. (2001) Autoregulation of cerebral blood flow in patients resuscitated from cardiac arrest. Stroke 32: 128–132

    PubMed  CAS  Google Scholar 

  84. Swan H, Zeavin I, Blount SG et al. (1953) Surgery by direct vision in the open heart during hypothermia. JAMA 153: 1081–1085

    CAS  Google Scholar 

  85. Torlinska T, Perz M, Madry E et al. (2002) Effect of hypothermia on insulin-receptor interaction in different rat tissues. Physiol Res 51: 261–266

    PubMed  CAS  Google Scholar 

  86. Van den Berghe G, Wouters P, Weekers F et al. (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345: 1359–1367

    Article  Google Scholar 

  87. Vargas Hein O, Triltsch A, Buch C von et al. (2004) Mild hypothermia after near drowning in twin toddlers. Crit Care 8: R353–R357

    Article  Google Scholar 

  88. Virkkunen I, Yli-Hankala A, Silfvast T (2004) Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer’s solution: a pilot study. Resuscitation 62: 299–302

    Article  PubMed  Google Scholar 

  89. Wolfrum S, Kurowski V (2007). Hypothermia after in-hospital cardiac arrest. http://clinicaltrials.gov/show/NCT00457431

  90. Wolfrum S, Radke PW, Pischon T et al. (2007) Mild therapeutic hypothermia after cardiac arrest – a nationwide survey on the implementation of the ILCOR guidelines in German intensive care units. Resuscitation 72: 207–213

    Article  PubMed  Google Scholar 

  91. Xu L, Yenari MA, Steinberg GK et al. (2002) Mild hypothermia reduces apoptosis of mouse neurons in vitro early in the cascade. J Cereb Blood Flow Metab 22: 21–28

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum der Universität zu Köln, Köln, Deutschland

    A. Schneider, P. Teschendorf & B.W. Böttiger

  2. Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    E. Popp

Authors
  1. A. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Popp
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Teschendorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B.W. Böttiger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Schneider.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schneider, A., Popp, E., Teschendorf, P. et al. Therapeutische Hypothermie. Anaesthesist 57, 197–208 (2008). https://doi.org/10.1007/s00101-008-1311-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-008-1311-4

Schlüsselwörter

Keywords

Search

Navigation