Hypothermia in multisystem trauma.
Exsanguinating hemorrhage is a common clinical feature of multisystem trauma that results in death or severe disability. Cardiovascular collapse resulting from hemorrhage is unresponsive to conventional methods of cardiopulmonary resuscitation. Even when bleeding is controlled rapidly, adequate circulation cannot be restored in time to avoid neurologic consequences that appear after only 5 mins of cerebral ischemia and hypoperfusion. Reperfusion adds further insult to injury. A novel solution to this problem would be to institute a therapy that makes cells and organs more resistant to ischemic injury, thereby extending the time they can tolerate such an insult. Hypothermia can attenuate some effects of ischemia and reperfusion. Accumulating preclinical data demonstrate that hypothermia can be induced safely and rapidly to achieve emergency preservation for resuscitation during lethal hemorrhage. Hypothermia may be an effective therapeutic approach for otherwise lethal traumatic hemorrhage, and a clinical trial to determine its utility is warranted.
Fukudome
Eugene Y
EY
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Alam
Hasan B
HB
D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002423:Cause of Death; D017281:Cost of Illness; D003422:Critical Care / Q000379:methods* / Q000639:trends; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005544:Forecasting; D006801:Humans; D007035:Hypothermia / Q000209:etiology; D007036:Hypothermia, Induced / Q000379:methods* / Q000639:trends; D015337:Multicenter Studies as Topic; D009104:Multiple Trauma / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D018579:Patient Selection; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control; D012771:Shock, Hemorrhagic / Q000209:etiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology