The dismal outcome after cardiac arrest calls for novel therapeutic approaches. Therapeutic hypothermia is a promising therapeutic modality. In this article we review the evidence for therapeutic hypothermia, for the best methods for cooling available and for the safety of therapeutic hypothermia.
HolzerMBernardSAHachimi-IdrissiS. Hypothermia for neuroprotection after cardiopulmonary resuscitation; systematic review and individual patient data meta-analysis. Crit Care Med2005;33: 414–18.
2.
MayerSA. Hypothermia for neuroprotection after cardiac arrest. Current Neurol Neurosci Rep2002;2: 525–26.
3.
BernardSA. Outcome from prehospital cardiac arrest in Melbourne, Australia. Emerg Med1998;10: 25–9.
4.
SafarPBehringerW. Cerebral resuscitation potentials for cardiac arrest. Crit Care Med2002;30(supp 4):S140–44.
5.
SackettDL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest1995;2: 2S–4S.
The Hypothermia After Cardiac Arrest Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. New Engl J Med2002;346: 549–56.
8.
BernardSAGrayTWBuistMD. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. New Engl J Med2002;346: 557–63.
9.
EdgrenEHedstandUKelsyS. Assessment of neurological prognosis in comatose survivors of cardiac arrest. Lancet1994;343: 1055–59.
10.
MadlCHolzerM. Brain function after resuscitation after cardiac arrest. Curr Opin Crit Care2004;10: 213–17.
11.
WhiteBCSullivanJMDeGraciaDJ. Brain ischaemia and reperfusion: molecular mechanisms of neuronal injury. J Neurol Sci2000;179: 1–33.
Pellegrini-GiampiatroDEChericiGAlesianiM. Excitatory amino acids release and free radical formation may co-operate in the genesis of ischaemia-induced neuronal damage. J Neurosci1990;10: 1035–41.
14.
MildeLN. Clinical use of mild hypothermia for brain protection: a dream revisited. J Neurosurg Anesthesiol1992;4: 211–15.
15.
EisenbergerPSterzFHolzerM. Therapeutic hypothermia after cardiac arrest. Current Opin Crit Care2000;7: 184–88.
16.
BigelowWGLindsayWKGreenwoodWF. Hypothermia: Its possible role in cardiac surgery: An investigation of factors governing survival in dogs at low body temperatures. Ann Surg1950;132: 849–66.
17.
RosomoffHL. Protective effects of hypothermia against pathological processes of the nervous system. Ann New York Acad Sci1959;80: 475–86.
18.
LeonovYSterzFSafarP. Mild cerebral hypothermia during and after cardiac arrest improves neurologic outcome in dogs. J Cereb Blood Flow Met1990;10: 57–70.
19.
GreenEJDietrichWDVan DijkF. Protective effects of brain hypothermia on behaviour and histopathology following global cerebral ischaemia in rats. Brain Resus1992;580: 197–204.
20.
WeinrauchVSafarPTishermanS. Beneficial effect of mild hypothermia and detrimental effect of deep hypothermia after cardiac arrest in dogs. Stroke1992;23: 1454–62.
21.
PoldermanKH. Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1: Indications and evidence. Intensive Care Med2004;30: 556–75.
22.
HickeyRWFerimerHAlexanderHL. Delayed, spontaneous hypothermia reduces neuronal damage after asphyxial cardiac arrest in rats. Crit Care Med2000;28: 3511–16.
23.
CoimbraCWielochT. Hypothermia ameliorates neuronal survival when induced 2 hours after ischaemia in the rat. Acta Physiol Scand1992;146: 543–44.
24.
ColbourneF. Li H, Buchan AM. Indefatigable CA1 sector neuroprotection with mild hypothermia induced 6 hours after severe forebrain ischemia in rats. J Cereb Blood Flow Metab1999;19: 742–49.
25.
LeonovYSterzFSafarP. Moderate hypothermia after cardiac arrest of 17 minutes in dogs. Effects on cerebral and cardiac outcome. A preliminary study. Stroke1990;21: 1600–06.
26.
SterzFSafarPTishermanS. Mild hypothermic cardiopulmonary resuscitation improves outcome after prolonged cardiac arrest in dogs. Crit Care Med1991;19: 379–89.
27.
SterzFHolzerM. Hypothermia after cardiac arrest: a treatment that works. Curr Opin Crit Care2003;9: 205–10.
28.
SafarP. Cerebral resuscitation after cardiac arrest: a review. Circulation1986;74: IV 138–53.
29.
GinsbergMDSternauLLGlobusMY. Therapeutic modulation of brain temperature: relevance to ischemic brain injury. Cerebrovasc Brain Metab Rev1992;4: 189–225.
30.
HicksSDDeFrancoDBCallawayCW. Hypothermia during reperfusion after asphyxial cardiac arrest improves functional recovery and selectively alters stress-induced protein expression. J Cereb Blood Flow Metab2000;20: 520–30.
31.
XiaoFSafarPRadovskyA. Mild protective and resuscitative hypothermia for asphyxial cardiac arrest in rats. Am J Emerg Med1998;16: 17–25.
32.
SafarP. Mild resuscitative hypothermia and outcome after cardiopulmonary resuscitation. J Neurosurg Anesthesiol1996;8: 88–96.
33.
HolzerMBernardSAHachimi-Idrissi. Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis. Crit Care Med2005;33: 414–18.
34.
Hachimi-IdrissiSCorneLEbingerG. Mild hypothermia induced by a helmet device: a clinical feasibility study. Resuscitation2001;51: 275–81.
35.
NolanJPMorleyPTVanden HoekTL. Therapeutic hypothermia after cardiac arrest: An advisory statement by the advanced life support task force of the international liaison committee on resuscitation. Circulation2003;108: 118–21.
36.
NolanJPDeakinCSoarJ. European Resuscitation Council Guidelines for Resuscitation 2005. Resuscitation2005; Supplement 1: S39–S86.
37.
KuboyamaKSafarPRadovskyA. Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac arrest in dogs: a prospective, randomized study. Crit Care Med1993;21: 1348–58.
38.
TheardMATempelhoffRCrowderRM. Convection versus conduction cooling for induction of mild hypothermia during neurovascular procedures in adults. J Neurosurg Anesthesiol1997;9: 250–55.
39.
PoldermanK. Application of therapeutic hypothermia in the intensive care unit: practical aspects and side effects. Intensive Care Med2004;30: 757–69.
40.
MerchantRMBenjaminSAPeberdyMA. Therapeutic hypothermia after cardiac arrest: Unintentional overcooling is common using ice packs and conventional cooling blankets. Crit Care Med2006;34: S490–94.
41.
Al-SenaniFMGraffagninoCGrottaJC. A prospective, multicenter pilot study to evaluate the feasibility and safety of using the CoolGardTM System and IcyTM catheter following cardiac arrest. Resuscitation2004;62: 143–50.
42.
FlintACHemphillJCBonovichDC. Therapeutic hypothermia after cardiac arrest: performance characteristics and safety of surface cooling with or without endovascular cooling. Neurocrit Care2007;7: 109–18.
43.
PiepgrasARothHSchurerL. Rapid active internal core cooling for induction of moderate hypothermia in head injury by use of an extracorporeal heat exchanger. Neurosurgery1998;42: 317–18.
BernardSBuistMMonteiroO. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation2003;56: 9–13.
46.
KimFOlsufkaMCarlbomD. Pilot study of rapid infusion of 2 L of 4°C normal saline for induction of mild hypothermia in hospitalized, comatose survivors of out-of-hospital cardiac arrest. Circulation2005;112: 715–19.
47.
PoldermanKHRijnsburgerERPeerdemanSM. Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid. Crit Care Med2005;33: 2744–51.
48.
KliegelAJanataAWandallerC. Cold infusions alone are effective for induction of therapeutic hypothermia but do not keep patients cool after cardiac arrest. Resuscitation2007;73: 46–53.
49.
KimFOlsufkaMLongstrethWT. Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4°C normal saline. Circulation2007;115: 3064–70.
50.
KimuraASakuradaSOhkuniH. Moderate hypothermia delays pro-inflammatory cytokine production of human peripheral blood mononuclear cells. Crit Care Med2002;30: 1499–502.
51.
BernardSAJonesBMBuistM. Experience with prolonged induced hypothermia in patients with severe head injury. Critical Care1999;3: 167–72.
52.
ValeriCRFeingoldHCassidyG. Hypothermia-induced reversible platelet dysfunction. Ann Surg1987;205: 175–81.
53.
TortoriciMAKochanekPMPoloyacSM. Effects of hypothermia on drug disposition, metabolism, and response: a focus of hypothermia-mediated alterations on the cytochrome P450 enzyme system. Crit Care Med2007;35: 2196–204.
