Therapeutic hypothermia translates from ancient history in to practice.
Acute postasphyxial encephalopathy around the time of birth remains a major cause of death and disability. The possibility that hypothermia may be able to prevent or lessen asphyxial brain injury is a "dream revisited". In this review, a historical perspective is provided from the first reported use of therapeutic hypothermia for brain injuries in antiquity, to the present day. The first uncontrolled trials of cooling for resuscitation were reported more than 50 y ago. The seminal insight that led to the modern revival of studies of neuroprotection was that after profound asphyxia, many brain cells show initial recovery from the insult during a short "latent" phase, typically lasting ~6 h, only to die hours to days later during a "secondary" deterioration phase characterized by seizures, cytotoxic edema, and progressive failure of cerebral oxidative metabolism. Studies designed around this conceptual framework showed that mild hypothermia initiated as early as possible before the onset of secondary deterioration, and continued for a sufficient duration to allow the secondary deterioration to resolve, is associated with potent, long-lasting neuroprotection. There is now compelling evidence from randomized controlled trials that mild induced hypothermia significantly improves intact survival and neurodevelopmental outcomes to midchildhood.
Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.
Alistair J
AJ
Gunn
Department of Neonatology, Warren Alpert Medical School, Brown University, Women & Infants Hospital, Providence, Rhode Island.
Abbot R
AR
Laptook
Institute for Women's Health, University College London, London, UK.
Nicola J
NJ
Robertson
Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.
John D
JD
Barks
Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK.|Department of Physiology, University of Oslo, Oslo, Norway.
Marianne
M
Thoresen
Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.
Guido
G
Wassink
Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.
Laura
L
Bennet
D000818:Animals; D001237:Asphyxia / Q000150:complications; D001238:Asphyxia Neonatorum / Q000266:history* / Q000628:therapy*; D001930:Brain Injuries; D049673:History, 20th Century; D049690:History, Ancient; D006801:Humans; D007036:Hypothermia, Induced / Q000266:history* / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000628:therapy; D007231:Infant, Newborn; D000066829:Neuroprotection; D016032:Randomized Controlled Trials as Topic; D012640:Seizures / Q000150:complications
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