Hypothermia in bleeding trauma: a friend or a foe?

Kheirbek, Tareq; Kochanek, Ashley R.; Alam, Hasan B.

doi:10.1186/1757-7241-17-65

Cited by 63 publications

(82 citation statements)

References 134 publications

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“…20 However, application of hypothermia in trauma patients or hemorrhagic shock victims is controversial. 21 Some authors suggest that trauma patients are already hypothermic, and further application of hypothermia can interfere with cardiac function, the activity of many enzymes, and with coagulation. However, other authors suggest that short-term and mild hypothermia would not significantly interfere with cardiovascular function and the activity of so many enzymes.…”

Section: Discussionmentioning

confidence: 99%

Short-term, Mild Hypothermia Can Increase the Beneficial Effect of Permissive Hypotension on Uncontrolled Hemorrhagic Shock in Rats

Lin

Zhu³

et al. 2012

Anesthesiology

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Background: Our previous and other studies have shown that hypotensive or hypothermic resuscitation have beneficial effects on uncontrolled hemorrhagic shock. Whether hypothermia can increase the beneficial effect of hypotensive resuscitation on hemorrhagic shock is not known. Methods: Two-hundred and twenty Sprague-Dawley rats were used to make uncontrolled hemorrhagic shock. Before bleeding was controlled, rats received normotensive or hypotensive resuscitation (target mean arterial pressure at 80 or 50 mmHg) in combination with normal (37°C) or mild hypothermia (34°C) (phase II). After bleeding was controlled, rats received whole blood and lactated Ringer's solution resuscitation for 2 h (phase III). The animal survival, blood loss, fluid requirement, cardiac output, and coagulation functions, as well as vital organ function, mitochondrial function, and energy metabolism of liver, kidney and intestines, were noted. Results: Short-term, mild hypothermia before bleeding was controlled increased the beneficial effect of hypotensive resuscitation. Hypothermia further decreased blood loss, oxygen consumption, and functional damage to the liver, kidney, and intestines during hypotensive resuscitation, pro-

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Section: Discussionmentioning

confidence: 99%

Short-term, Mild Hypothermia Can Increase the Beneficial Effect of Permissive Hypotension on Uncontrolled Hemorrhagic Shock in Rats

Lin

Zhu³

et al. 2012

Anesthesiology

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“…This reduction in blood flow to injured tissue in turn reduces edema and hemorrhaging into the tissue and limits the induction of inflammation. [2][3][4][5] Topical application of either menthol or ice appears to be effective in decreasing arterial perfusion. Ice has a vasoconstrictive effect: it lowers the temperature of the tissues, which stimulates the thermoreceptors and local chemical reactions that result in vasoconstriction.…”

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confidence: 99%

Topical Menthol, Ice, Peripheral Blood Flow, and Perceived Discomfort

Topp

Ledford

Jacks

2013

Journal of Athletic Training

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†University of Louisville, KY Context: Injury management commonly includes decreasing arterial blood flow to the affected site in an attempt to reduce microvascular blood flow and edema and limit the induction of inflammation. Applied separately, ice and menthol gel decrease arterial blood flow, but the combined effects of ice and menthol gel on arterial blood flow are unknown.Objectives: To compare radial artery blood flow, arterial diameter, and perceived discomfort before and after the application of 1 of 4 treatment conditions.Design: Experimental crossover design. Setting: Clinical laboratory. Participants or Other Participants: Ten healthy men, 9 healthy women (mean age ¼ 25.68 years, mean height ¼ 1.73 m, mean weight ¼ 76.73 kg).Intervention(s): Four treatment conditions were randomly applied for 20 minutes to the right forearm of participants on 4 different days separated by at least 24 hours: (1) 3.5 mL menthol gel, (2) 0.5 kg of crushed ice, (3) 3.5 mL of menthol gel and 0.5 kg of crushed ice, or (4) no treatment (control).Main Outcome Measure(s): Using high-resolution ultrasound, we measured right radial artery diameter (cm) and blood flow (mL/min) every 5 minutes for 20 minutes after the treatment was applied. Discomfort with the treatment was documented using a 1-to-10 intensity scale.Results: Radial artery blood flow decreased (P , .05) from baseline in the ice (À20% to À24%), menthol (À17% to À24%), and ice and menthol (À36% to À39%) treatments but not in the control (3% to 9%) at 5, 10, and 15 minutes. At 20 minutes after baseline, only the ice (À27%) and combined ice and menthol (À38%) treatments exhibited reductions in blood flow (P , .05). Discomfort was less with menthol than with the ice treatment at 5, 10, and 20 minutes after application (P , .05). Arterial diameter and heart rate did not change.Conclusions: The application of 3.5 mL of menthol was similar to the application of 0.5 kg of crushed ice in reducing peripheral blood flood. Combining crushed ice with menthol appeared to have an additive effect on reducing blood flow.Key Words: rehabilitation, modalities, cryotherapy Key PointsThe ice, menthol, and ice-plus-menthol treatments all resulted in reduced blood flow compared with the control condition and with baseline. The ice-plus-menthol treatment resulted in a more rapid and greater reduction in blood flow.

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“…hypothermia secondary to HS that occurs following injuries is linked with increased mortality [5,6] and indicates depleted energy stores and disrupted cellular homeostasis [7]. It, along with coagulopathy and acidosis, comprise a "lethal triad" that results in deleterious outcomes in trauma patients.…”

mentioning

confidence: 99%

Pre-Hospital Induced Hypothermia Improves Outcomes in a Pig Model of Traumatic Hemorrhagic Shock

Zhou¹,

Wang²,

Nanhai³

et al. 2015

Adv Clin Exp Med

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Background. Extensive preclinical evidence suggests that induced hypothermia can protect tissues from ischemiareperfusion injury, reduce organ damage, and improve survival in the advanced stages of shock. Objectives. We assessed the effects of induced hypothermia on the hemodynamic parameters and coagulation capacity during hemorrhagic shock (HS) and fluid resuscitation, in a pig model of HS with multiple intestinal perforations. Material and Methods. Pigs (n = 16) were randomized into 2 groups: a hypothermia (HT) group (n = 8, 34°C) and a normothermia (NT) group (n = 8, 38°C). Hypothermia to 34°C was induced with a cold blanket at the pre-hospital stage. Traumatic HS shock was induced using multiple intestinal perforations. Pulse indicator continuous cardiac output (PiCCO) was used to monitor hemodynamic changes. Coagulation capacity was measured using thromboelastography (TEG) at baseline as well as during resuscitation periods. Survival was documented for 72 h post-trauma. Results. Mortality in the hypothermic HS group was low, but there were no significant differences in mortality between the groups (mortality = 2/8 HT vs. 5/8 NT, p = 0.137). During hypothermia, the heart rate, extravascular lung water index (EVLWI), oxygen uptake index (VO2), and oxygen delivery index (DO2) in the HT group were significantly lower than those in the NT group. There were no significant differences between the 2 groups in the other hemodynamic indices or prothrombin time. Analyses of thromboelastometry at 34°C during hypothermia showed significant differences for reaction time (R) and alpha angle, but not for maximal amplitude (MA). Conclusions. Rewarming reversed the coagulation changes induced by hypothermia. Induced mild hypothermia (34°C) in the pre-hospital stage affects hemodynamic parameters and the coagulation system but does not worsen outcomes in a pig HS model. The hypothermia-induced coagulation changes were reversed during rewarming without evidence of harmful effects. Our results suggest that pre-hospital induced hypothermia can be performed carefully following major trauma (Adv Clin Exp Med 2015, 24, 4, 571-578).

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Hypothermia in bleeding trauma: a friend or a foe?

Cited by 63 publications

References 134 publications

Short-term, Mild Hypothermia Can Increase the Beneficial Effect of Permissive Hypotension on Uncontrolled Hemorrhagic Shock in Rats

Short-term, Mild Hypothermia Can Increase the Beneficial Effect of Permissive Hypotension on Uncontrolled Hemorrhagic Shock in Rats

Topical Menthol, Ice, Peripheral Blood Flow, and Perceived Discomfort

Pre-Hospital Induced Hypothermia Improves Outcomes in a Pig Model of Traumatic Hemorrhagic Shock

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