Clinical applications of hypothermia range from ex vivo storage
of cells, tissues and organs for transplantation or cell-based
therapies to in vivo protection of a patient during complex surgeries
that might entail circulatory and/or cardiac arrest. The intent
of this brief review is to outline the essential principles of
hypothermia applied in the preservation of cells for a multitude
of clinical purposes. The focus will be confined to our ability as
interventionalists to control the environment of cells to optimize
hypothermic preservation. More specifically, this review will
summarize the design principles of hypothermic blood substitutes
(HBS) defined as preservation solutions for protection of
cells, tissues and organs during a hypothermic preservation interval.
In contrast to the types of solutions that have been used
historically as hemodiluents for clinical hypothermia, i.e. normal
physiologically balanced salt solutions, our approach has
been to design aqueous blood substitutes that embody many of
the principles now identified as contributory and important for
optimal ex vivo organ preservation. The working hypothesis
that we have addressed using a variety of pre-clinical large animal
models is that acellular solutions can be designed to act as
universal tissue preservation solutions during several hours of
hypothermic whole-body washout involving cardiac arrest, with
or without circulatory arrest. On this basis, two new types of solutions,
designated ‘Purge’ and ‘Maintenance’ HBS, have been
formulated and evaluated to fulfill separate requirements during
the asanguineous procedure. The evidence supporting this
concept is reviewed in the context of imminent clinical trials to
apply this novel technique for the preservation and resuscitation
of trauma victims suffering hemorrhagic shock.