Expedited brain cooling: Persistent temperature management from first aid to interhospital treatment

Abstract

Selective brain cooling is a promising technique for improving outcomes in ischemic stroke in the area of reperfusion. A recent study described the efficacy of a new method of selective brain cooling via active conductive head cooling. This is a major step forward in the administration of hypothermic treatment during pre-hospital transfer. However, to enhance the benefits of selective therapeutic cooling, a more comprehensive strategy preventing delay in hypothermic induction and increasing the accuracy of selectivity in the brain should be considered to mitigate the side effects related to therapeutic hypothermia.

Penumbral cooling in ischemic stroke with intraarterial, intravenous or active conductive head cooling: A thermal modeling study

“…So although intraarterial cooling may be effective at inducing penumbral hypothermia, adjunctive methods to induce penumbral cooling in the minutes or hours leading up to EVT, and to slow rewarming after cessation of intraarterial cooling are required. 6…”

“…So although intraarterial cooling may be effective at inducing penumbral hypothermia, adjunctive methods to induce penumbral cooling in the minutes or hours leading up to EVT, and to slow rewarming after cessation of intraarterial cooling are required. 6 Intravenous cooling resulted in penumbral temperatures of 35.4-35.8 C. Previous studies have shown that intravenous cooling may be effective at inducing and maintaining modest hypothermia but is practically difficult to administer. Intravenous cooling is also an indirect method of cooling the penumbra as it requires the induction of systemic hypothermia to remove heat from the non-ischemic and ischemic brain tissue, and this can lead to significant side effects.…”

“…1,2 There has been re-emerging interest in strategies that aim to protect the ischemic penumbra in patients undergoing endovascular thrombectomy (EVT) in the prehospital setting, and during interhospital transfer, and the procedure itself. [3][4][5][6] Methods for inducing hypothermia in stroke patients include body surface cooling, intravenous cooling, intraarterial cooling and active conductive head cooling, where the scalp is cooled externally with a cooling cap. 6 These methods of inducing hypothermia are likely to have differential effects on the ischemic core, ischemic penumbra, and non-ischemic brain given that ischemic brain has reduced cerebral blood flow compared to the surrounding non-ischemic brain.…”

“…[3][4][5][6] Methods for inducing hypothermia in stroke patients include body surface cooling, intravenous cooling, intraarterial cooling and active conductive head cooling, where the scalp is cooled externally with a cooling cap. 6 These methods of inducing hypothermia are likely to have differential effects on the ischemic core, ischemic penumbra, and non-ischemic brain given that ischemic brain has reduced cerebral blood flow compared to the surrounding non-ischemic brain. Most clinical trials have focused on inducing systemic hypothermia through body surface or intravenous cooling, both of which are practically challenging and can lead to significant complications such as pneumonia.…”

Research progress of selective brain cooling methods in the prehospital care for stroke patients

“…Moreover, as other cytoprotective treatments, ice helmets have not been successfully applied in clinical trials to generate neuroprotection without reperfusion in previous studies. [ 20 ] After highly effective reperfusion therapy is widely available and the cooling rate is successfully improved, as adjuvant treatments to thrombolysis or endovascular thrombectomy, cooling helmets are promising to be neuroprotective for AIS.…”