Brain cooling maintenance with cooling cap following induction with intracarotid cold saline infusion: A quantitative model

Neimark, Matthew A.; Konstas, Angelos-Aristeidis; Choi, Jae Hyung; Laine, Andrew F.; Pile‐Spellman, John

doi:10.1016/j.jtbi.2008.03.025

Cited by 31 publications

(29 citation statements)

References 41 publications

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“…In this combined method, however, core body temperature was severely decreased because of the ice cap. 27 In the present study, interrupted ICSI induced a less drastic decrease in hematocrit levels than traditional ICSI, and the core body temperature was not significantly changed. Thus, this advantage improves the safety of the ICSI method.…”

Section: Discussioncontrasting

confidence: 41%

Interrupted intracarotid artery cold saline infusion as an alternative method for neuroprotection after ischemic stroke

Wu²,

Zhong³

et al. 2012

FOC

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Object Intracarotid artery cold saline infusion (ICSI) is an effective method for protecting brain tissue, but its use is limited because of undesirable secondary effects, such as severe decreases in hematocrit levels, as well as its relatively brief duration. In this study, the authors describe and investigate the effects of a novel ICSI pattern (interrupted ICSI) relative to the traditional method (uninterrupted ICSI). Methods Ischemic strokes were induced in 85 male Sprague-Dawley rats by occluding the middle cerebral artery for 3 hours using an intraluminal filament. Uninterrupted infusion groups received an infusion at 15 ml/hour for 30 minutes continuously. The same infusion speed was used in the interrupted infusion groups, but the whole duration was divided into trisections, and there was a 20-minute interval without infusion between sections. Forty-eight hours after reperfusion, H & E and silver nitrate staining were utilized for morphological assessment. Infarct sizes and brain water contents were determined using H & E staining and the dry-wet weight method, respectively. Levels of neuron-specific enolase (NSE), S100β protein, and matrix metalloproteinase 9 (MMP-9) in the serum were determined using enzyme-linked immunosorbent assay. Neurological deficits were also evaluated. Results Histology showed that interrupted ICSI did not affect neurons or fibers in rat brains, which suggests that this method is safe for brain tissues with ischemia. The duration of hypothermia induced by interrupted ICSI was longer than that induced via the traditional method, and the decrease in hematocrit levels was less pronounced. There were no differences in infarct size or brain water content between uninterrupted and interrupted ICSI groups, but neuron-specific enolase and matrix metalloproteinase 9 serum levels were more reduced after interrupted ICSI than after the traditional method. Conclusions Interrupted ICSI is a safe method. Compared with traditional ICSI, the interrupted method has a longer duration of hypothermia and less effect on hematocrit and offers more potentially improved neuroprotection, thereby making it more attractive as an infusion technique in the clinic.

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Section: Discussioncontrasting

confidence: 41%

Interrupted intracarotid artery cold saline infusion as an alternative method for neuroprotection after ischemic stroke

Wu²,

Zhong³

et al. 2012

FOC

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“…There was no change in R brain blood flow. Finally, Neimark and colleagues 37 created a quantitative brain cooling model and assessed the theoretical temperature changes in response to intracarotid cold saline infusion, a cooling cap, or a combination of both. The authors confirmed the inability of cooling caps alone to achieve cold temperatures deep within brain parenchyma, a finding that aligns with other research we have discussed.…”

Section: Vascular Cerebral Cooling Methodsmentioning

confidence: 99%

Selective therapeutic hypothermia: A review of invasive and noninvasive techniques

Straus

Prasad

Munoz

2011

Arq. Neuro-Psiquiatr.

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Objective: Therapeutic hypothermia is a promising treatment to prevent secondary neurologic injury. Clinical utility is limited by systemic complications of global hypothermia. Selective brain cooling remains a largely uninvestigated application. We review techniques of inducing selective brain cooling. Method: Literature review. Results: Strategies of inducing selective brain cooling were divided between non-invasive and invasive techniques. Non-invasive techniques were surface cooling and cooling via the upper airway. Invasive cooling methods include transvascular and compartmental (epidural, subdural, subarachnoid and intraventricular) cooling methods to remove heat from the brain. Conclusion: Selective brain cooling may offer the best strategy for achieving hypothermic neuroprotection. Non-invasive strategies have proven disappointing in human trials. There is a paucity of human experiments using invasive methods of selective brain cooling. Further application of invasive cooling strategies is needed. Key words: therapeutic hypothermia, selective brain cooling, neuroprotection, isolated cerebral hypothermia.Hipotermia terapêutica seletiva: uma revisão de técnicas invasivas e não invasivas RESUMO Objetivo: A hipotermia terapêutica é uma estratégia promissora para prevenção do dano neurológico secundário. Sua utilidade clínica é limitada por complicações sistêmicas da hipotermia global. Resfriamento cerebral seletivo (RCS), entretanto, permanece uma técnica pouco estudada. Revisamos aqui as diferentes técnicas de indução de RCS. Método: Revisão de literatura. Resultados: As estratégias de indução de RCS foram divididas em invasivas e não-invasivas. Métodos de remoção de calor do cérebro não-invasivos incluem o resfriamento de superfície e o de vias aéreas superiores; as técnicas invasivas incluem resfriamento transvascular e compartimental (epidural, subdural, subaracnóideo e intraventricular). Conclusão: RCS pode oferecer a melhor estratégia para alcançar neuroproteção hipotérmica. Estratégias não-invasivas têm se mostrado ineficazes em estudos clínicos. Técnicas invasivas foram raramente estudadas em humanos e necessitam ser mais investigadas para tornarem-se úteis. Palavras-Chave: hipotermia terapêutica, resfriamento cerebral seletivo, neuroproteção, hipotermia cerebral isolada.

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“…Thus, through the integrated neck cooling capability of our device and the expected use of cold saline infusion for TH induction, the arterial temperature should be sufficiently decreased for the device to still obtain its design goal during normal physiological perfusion. The combination of surface cooling and cold saline infusion has been shown to rapidly induce and maintain hypothermia [48]. (2) the average scalp temperature of six piglets cooled with a fluid circulating helmet [42], (3) the average scalp temperature of 16 patients with cardiac arrest cooled with the commercially available Frigicap V R [36], (4) the average scalp temperature of 24 healthy subjects cooled by a commercially available device from Life Support Systems [40], and (5) the scalp temperature of a healthy subject cooled by a commercial device available from Paxman Coolers Ltd. [41] …”

Section: Functionality and Comparison To Current Technologymentioning

confidence: 99%

A Head and Neck Support Device for Inducing Local Hypothermia

Gladen

Iaizzo

Bischof

et al. 2013

Journal of Medical Devices

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The present work describes the design of a device/system intended to induce local mild hypothermia by simultaneously cooling a patient's head and neck. The therapeutic goal is to lower the head and neck temperatures to 33-35 C, while leaving the core body temperature unchanged. The device works by circulating a cold fluid around the exterior of the head and neck. The head surface area is separated into five different cooling zones. Each zone has a cooling coil and can be independently controlled. The cooling coils are tightly wrapped concentric circles of tubing. This design allows for a dense packing of tubes in a limited space, while preventing crimping of the tubing and minimizing the fluid pressure head loss. The design in the neck region also has multiple tubes wrapping around the circumference of the patient's neck in a helix. Preliminary testing indicates that this approach is capable of achieving the design goal of cooling the brain tissue (at a depth of 2.5 cm from the scalp) to 35 C within 30-40 min, without any pharmacologic or circulatory manipulation. In a comparison with examples of current technology, the device has shown the potential for improved cooling capability.

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Brain cooling maintenance with cooling cap following induction with intracarotid cold saline infusion: A quantitative model

Cited by 31 publications

References 41 publications

Interrupted intracarotid artery cold saline infusion as an alternative method for neuroprotection after ischemic stroke

Interrupted intracarotid artery cold saline infusion as an alternative method for neuroprotection after ischemic stroke

Selective therapeutic hypothermia: A review of invasive and noninvasive techniques

A Head and Neck Support Device for Inducing Local Hypothermia

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