Therapeutic hypothermia and temperature management
-
Ther Hypothermia Temp Manag · Mar 2016
ReviewTemperature Management During Circulatory Arrest in Cardiac Surgery.
Surgery for complex aortic pathologies, such as acute dissections and aneurysms involving the aortic arch, remains one of the most technically and strategically challenging intervention in aortic surgery, requiring thorough understanding not only of cardiovascular physiology but also of neurophysiology (cerebral and spinal cord), and is still associated with significant mortality and morbidity. The introduction of deep hypothermia in the mid 1970s, allowing defined periods of circulatory arrest, has made possible the advent of modern aortic surgery requiring prolonged ischemic tolerance of central nervous system. In the late 1980s, when deep hypothermic circulatory arrest was the standard operative strategy for aortic surgery, selective cerebral perfusion, as an adjunct to deep hypothermia, made possible excellent neuroprotection and improved overall outcome. ⋯ The motivation for progressive temperature elevation was the limitation of adverse effects of deep hypothermia, in particular, reduction of systemic inflammatory response (and organ dysfunctions) and diminution of the risk of severe postoperative bleeding. However, adverse outcomes due to inappropriate temperature management (core temperatures too high for the required duration of circulatory arrest) are probably underreported. Indeed, complications historically associated with hypothermia are possibly overestimated.
-
Ther Hypothermia Temp Manag · Mar 2016
Comprehensive Evaluation of Neuroprotection Achieved by Extended Selective Brain Cooling Therapy in a Rat Model of Penetrating Ballistic-Like Brain Injury.
Brain hypothermia has been considered as a promising alternative to whole-body hypothermia in treating acute neurological disease, for example, traumatic brain injury. Previously, we demonstrated that 2-hours selective brain cooling (SBC) effectively mitigated acute (≤24 hours postinjury) neurophysiological dysfunction induced by a penetrating ballistic-like brain injury (PBBI) in rats. This study evaluated neuroprotective effects of extended SBC (4 or 8 hours in duration) on sub-acute secondary injuries between 3 and 21 days postinjury (DPI). ⋯ The protective effects of SBC on delayed axonal injury (silver staining) were evident out to 14 DPI. In conclusion, the CCA cooling method of SBC produced neuroprotection measured across multiple domains that were evident days/weeks beyond the cooling duration and in the absence of overt adverse effects. These "proof-of-concept" results suggest that SBC may provide an attractive neuroprotective approach for clinical considerations.
-
Ther Hypothermia Temp Manag · Mar 2016
An Assessment of Emergency Department Post-Cardiac Arrest Care Variation in Michigan.
Implementation of postarrest care by individual physicians and systems has been slow. Deadoption, or discontinuation of therapeutic hypothermia (TH) treatment targets, after recent prospective study results has not been well reported. This study assesses practices in the early stages of postarrest care across emergency departments (EDs) in Michigan. ⋯ On follow-up 12 months later, we received 33/40 (83%) responses, of which only 5 indicated formal or informal change in TH practice or target temperature. There is substantial variation in the practice of ED postarrest care and initiation of TH across the state of Michigan, but few ED TH protocols were changed in a year's time. The consequences of postarrest treatment variability at the state and ED levels are likely under-recognized as an influence on outcome variation between regions.