Neurologic and Cardiac Benefits of Therapeutic Hypothermia

Abstract

Numerous studies have shown the favorable effects of lowering the core temperature of the body in various conditions such as acute myocardial infarction, acute cerebrovascular disease, acute lung injury, and acute spinal cord injury. Therapeutic hypothermia (TH) works at different molecular and cellular levels. TH improves oxygen supply to ischemic areas and increases blood flow by decreasing vasoconstriction, as well as oxygen consumption, glucose utilization, lactate concentration, intracranial pressure, heart rate, cardiac output, and plasma insulin levels. TH has been shown to improve neurologic outcome in acute cerebrovascular accidents. Furthermore, recent studies revealed that TH is a useful method of neuroprotection against ischemic neuronal injury after cardiac arrest. TH in out-of-hospital cardiac arrest is becoming a standard practice nationwide. Further studies need to be performed to develop a better understanding of the benefits and detrimental effects of TH, to identify the most efficacious TH strategy, and the candidates most likely to derive benefit from the procedure. Although many animal studies have demonstrated benefit, larger human clinical trials are recommended to investigate the beneficial effect of TH on reducing myocardial infarction size and coronary reperfusion injuries.

Preconditioning provides neuroprotection in models of CNS disease: Paradigms and clinical significance

“…Brain cooling (hypothermia) has been recommended in emergency medicine in the protection against neurological injury following cardiac arrest due to ventricular fibrillation (Azmoon et al , 2011; Bernard, 2009). A brief period of hypothermia can also lead to preconditioning-like neuroprotection.…”

Placement of an Esophageal Temperature Probe by Nurses

“…1,[4][5][6] Cooling patients should be considered for all unconscious survivors of out-of-hospital ventricular tachycardia arrest 2 and patients experiencing in-hospital arrests. 2,4,7 Therapeutic hypothermia represents the intentional induction of a lowered core body temperature within different ranges of hypothermia: mild TH is an intentional and controlled reduction of a patient's core temperature to 34.0°C to 35.9°C, moderate TH is a reduction in temperature to 32.0° to 33.9°C, and moderate to deep TH is a reduction in temperature to 30.0°C to 31.9°C. 2,4,7 Therapeutic hypothermia represents the intentional induction of a lowered core body temperature within different ranges of hypothermia: mild TH is an intentional and controlled reduction of a patient's core temperature to 34.0°C to 35.9°C, moderate TH is a reduction in temperature to 32.0° to 33.9°C, and moderate to deep TH is a reduction in temperature to 30.0°C to 31.9°C.…”

“…1 Cardiopulmonary resuscitation remains the stable force in providing resuscitation to victims of cardiac arrest. 2 An essential element of TH is accurate monitoring of body temperature. In the event the patient is successfully resuscitated, therapies such as therapeutic hypothermia (TH) have played an important role in early resuscitation and have provided neuroprotection against ischemic neuronal injury following cardiac arrest.…”

Regional Hypothermia Inhibits Spinal Cord Somatosensory-Evoked Potentials without Neural Damage in Uninjured Rats

“…16 Hypothermia, which has been studied since the 1960s, has been shown to be a neuroprotective procedure that reduces oxygen consumption and metabolic rate, stabilizes local blood flow, inhibits the release of excitatory neurotransmitters, and ultimately reduces neuron apoptosis. 17,18 Although systemic hypothermia has been used for TSCI treatment as reported by Cappuccino, 19 its large-scale application is limited because of whole-body complications, such as shivering, increased susceptibility of infection caused by immunosuppression, electrolyte disorders, insulin resistance, impaired drug clearance, and mild coagulopathy. 20-24 RH, which is localized, is considered to be effective and much safer than systemic cooling.…”