title: Therapeutic hypothermia for out-of-hospital cardiac arrest: an update for neurosurgeons.
abstract: BACKGROUND
  Neurosurgeons have been familiar with the idea that hypothermia is protective against various types of brain injuries, including traumatic brain injury (TBI). Recent randomized controlled trials, however, have failed to demonstrate the efficacy of therapeutic hypothermia (TH) in patients with TBI. On the other hand, TH becomes popular in the treatment of out-of-hospital cardiac arrest (OHCA) survivors, after randomized controlled trials have shown that survival rate and functional outcome is improved with the use of TH in selected patients. We believe that knowledge on the recent progress in TH for OHCA is useful for neurosurgeons, because feedback of information obtained in the treatment of OHCA may revitalize the interest in TH for neurosurgical disorders, particularly TBI.
  
  
  METHODS
  A review of the literature was conducted with the use of PubMed.
  
  
  RESULTS
  Various cooling techniques and devices have been developed and trialed in the treatment of OHCA survivors, including prehospital cooling with bolus ice-cold saline, endovascular cooling catheters, and new generation surface cooling devices, some of which have already been known to neurosurgeons. The efficacy of these new methods and devices has been demonstrated in many preliminary studies, and phase III trials are also expected.
  
  
  CONCLUSIONS
  Neurosurgeons and critical care medicine physicians pursue the same goal of rescuing the brain from the secondary injury despite the difference in etiology (focal trauma vs. global ischemia), with the presumption that earlier and faster implementation of TH will result in better outcome. Thoughtful application of knowledge and techniques obtained in OHCA to TBI under a rigorously controlled situation will make a small, but significant difference in the outcome of TBI victims.
authors.affiliation: Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan. ginamasu@aol.com
authors.forename: Joji
authors.initials: J
authors.lastname: Inamasu
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakatsukasa
authors.forename: Masaru
authors.initials: M
authors.lastname: Suzuki
authors.forename: Satoru
authors.initials: S
authors.lastname: Miyatake
mesh_terms: D001925:Brain Damage, Chronic / Q000517:prevention & control; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy; D003422:Critical Care / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods*; D005240:Feasibility Studies; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation / Q000379:methods*; D009493:Neurosurgery; D016032:Randomized Controlled Trials as Topic; D017694:Rewarming / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome