Therapeutic hypothermia in traumatology.
Despite its proven clinical application for protection-preservation of the brain and heart during cardiac surgery, hypothermia research has fallen in and out of favor many times since its inception. Since the 1980s, there has been renewed research and clinical interest in therapeutic hypothermia for resuscitation of the brain after cardiac arrest or TBI and for preservation-resuscitation of extracerebral organs, particularly the abdominal viscera in low-flow states such as HS. Although some of the fears regarding the side effects of hypothermia are warranted, others are not. Without further laboratory and clinical studies, the significance of these effects cannot be determined and ways to overcome these problems cannot be developed. Currently, at the turn of the century, there are significant data demonstrating the benefit of mild-to-moderate hypothermia in animals and humans after cardiac arrest or TBI and in animals during and after HS. The clinical implications of uncontrolled versus controlled hypothermia in trauma patients and the best way to assure poikilothermia for cooling without shivering are still unclear. It is time to consider a prospective trial of therapeutic, controlled hypothermia for patients during traumatic HS and resuscitation. The authors believe that the new millennium will witness remarkable advantages of the use of controlled hypothermia in trauma. Starting in the prehospital phase, mild hypothermia will be induced in hypovolemic patients, which will not only decrease the immediate mortality rate but perhaps also will protect cells and reduce the likelihood of secondary inflammatory response syndrome, multiple organ failure, and late deaths. The most futuristic applications will be hypothermic strategies to achieve prolonged suspended animation for delayed resuscitation in traumatic exsanguination cardiac arrest.
Tisherman
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SA
Safar Center for Resuscitation Research, University of Pittsburgh, Pennsylvania, USA. tishermansa@msx.upmc.edu
Rodriguez
A
A
Safar
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P
D000818:Animals; D001930:Brain Injuries / Q000628:therapy; D004632:Emergency Medical Services; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007035:Hypothermia / Q000503:physiopathology; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods; D009102:Multiple Organ Failure / Q000517:prevention & control; D011446:Prospective Studies; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000628:therapy; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000517:prevention & control; D014947:Wounds and Injuries / Q000601:surgery*