Therapeutic hypothermia for brain injury after cardiac arrest.
Morbidity and mortality in patients successfully resuscitated from cardiac arrest primarily depends on neurological outcome. Clinical trials of therapies directed toward reducing the extent of neuronal damage by means of pharmacological agents have been disappointing. To date, the only clinically effective tool for amelioration of brain damage by ischemia and reperfusion is mild to moderate induced hypothermia. The pathophysiology of global hypoxic-ischemic brain injury, the mechanisms by which hypothermia confers neuroprotection, and the encouraging beneficial effects of mild to moderate hypothermia in experimental studies and clinical trials are discussed.
Rincon
Fred
F
Neurological Intensive Care Unit, Division of Stroke and Critical Care, Department of Neurology, Columbia University, New York, New York, USA.
Mayer
Stephan A
SA
D001921:Brain / Q000098:blood supply / Q000378:metabolism / Q000503:physiopathology*; D020520:Brain Infarction / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D002560:Cerebrovascular Circulation / Q000502:physiology; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000592:standards / Q000639:trends*; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D015427:Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications