Journal of neurotrauma
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Journal of neurotrauma · Mar 2009
ReviewThe use of pre-hospital mild hypothermia after resuscitation from out-of-hospital cardiac arrest.
Hypothermia has emerged as a potent neuroprotective modality following resuscitation from cardiac arrest. Although delayed hospital cooling has been demonstrated to improve outcome after cardiac arrest, in-field cooling begun immediately following the return of spontaneous circulation may be more beneficial. ⋯ Rapid infusion of intravenous fluid at 4 degrees C, the use of a cooling helmet, and cooling plates have all been proposed as methods for field cooling, and are all in various stages of clinical and animal testing. Whether field cooling will improve survival and neurologic outcome remains an important unanswered clinical question.
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Journal of neurotrauma · Mar 2009
ReviewHypothermia after cardiac arrest: lessons learned from national registries.
Therapeutic hypothermia has been shown to improve outcome in comatose survivors after cardiac arrest of cardiac origin. After the clinical implementation of this novel treatment, several international web-based registries were opened to facilitate the prospective collection of patient treatment data. The aim was to evaluate the actual use of hypothermia in clinical practice, safety aspects, resource utilization, and outcome in large cohorts of patients. ⋯ The three registries have different strengths and weaknesses, but the clinical outcome compares well with that of the two randomized trials. Our conclusions are that hypothermia is feasible to implement, that it seems reasonably safe, and that the outcome compares well with previous reports. We also conclude that the treatment with hypothermia after cardiac arrest is more widely applied than what is strictly evidence based.
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Preclinical as well as clinical studies in traumatic brain injury (TBI) have established the likely association of secondary injury and outcome in adults in children following severe injury. Similarly, there is growing evidence in experimental laboratory studies that moderate hypothermia has a beneficial effect on outcome, though the exact mechanisms remain to be absolutely defined. ⋯ Further preliminary randomized clinical trials, both single institution and multicenter, have provided the initial data on safety and efficacy, though larger, Phase III studies are necessary to ensure both the safety and efficacy of hypothermia in pediatric TBI prior to implementation as part of the standard of care. It is expected that hypothermia initiated early after severe TBI will have a protective effect on the pediatric brain and can be done safely, but this still remains to be definitively tested.
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Journal of neurotrauma · Mar 2009
ReviewHypothermia in focal ischemia: implications of experiments and experience.
Beside aspirin administration and stroke unit care, thrombolysis is the only approved and effective therapy in acute ischemic stroke. Thrombolysis is essentially limited by the short therapeutic window and its potential side effects. Although there is a robust body of evidence on the neuroprotective characteristics of hypothermia in animal models of focal ischemia, the clinical data on hypothermia in stroke are inconclusive in terms of effectiveness. ⋯ This lack of efficacy might be explained by the fact that hypothermia is not appropriately used in patients and animal data are not correctly interpreted. This review summarizes the major conclusions of animal studies and presents results of clinical stroke trials to date. Methods of delivery and maintenance of hypothermia are discussed, as well as a variety of open questions in the relevant animal and clinical research.
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Induced hypothermia after ischemic stroke is a promising neuroprotective therapy and is the most potent in pre-clinical models. Technological limitations and homeostatic mechanisms that maintain core body temperature, however, have limited the clinical application of hypothermia. Advances in intravascular cooling and successful trials of hypothermia after global cerebral ischemia, such as in cardiac arrest and neonatal asphyxia, have renewed interest in hypothermia for stroke.