State of the art in therapeutic hypothermia.
Historically, hypothermia was induced prior to surgery to enable procedures with prolonged ischemia, such as open heart surgery and organ transplant. Within the past decade, the efficacy of hypothermia to treat emergency cases of ongoing ischemia such as stroke, myocardial infarction, and cardiac arrest has been studied. Although the exact role of ischemia/reperfusion is unclear clinically, hypothermia holds significant promise for improving outcomes for patients suffering from reperfusion after ischemia. Research has elucidated two distinct windows of opportunity for clinical use of hypothermia. In the early intra-ischemia window, hypothermia modulates abnormal cellular free radical production, poor calcium management, and poor pH management. In the more delayed post-reperfusion window, hypothermia modulates the downstream necrotic, apoptotic, and inflammatory pathways that cause delayed cell death. Improved cooling and monitoring technologies are required to realize the full potential of this therapy. Herein we discuss the current state of clinical practice, clinical trials, recommendations for cooling, and ongoing research on therapeutic hypothermia.
Lampe
Joshua W
JW
The Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA.
Becker
Lance B
LB
D000818:Animals; D002985:Clinical Protocols; D002986:Clinical Trials as Topic; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000628:therapy; D009203:Myocardial Infarction / Q000628:therapy; D015427:Reperfusion Injury / Q000378:metabolism / Q000628:therapy; D020521:Stroke / Q000628:therapy; D016896:Treatment Outcome