Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac arrest in dogs

Kuboyama, Kazutoshi; Šafář, Peter; Radovsky, Ann; Tisherman, Samuel A.; Stezoski, S. William; Alexander, Henry

doi:10.1097/00003246-199309000-00019

Cited by 485 publications

(232 citation statements)

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“…In addition, it will be most meaningful clinically if hypothermia protects when applied postischemically; however, therapeutic time windows for postischemic hypothermia are limited. For example, mild hypothermia applied 15 mins after reperfusion failed to improve neurologic function in global ischemia, whereas it protected when applied immediately after reperfusion (Kuboyama et al, 1993). This therapeutic time window might be similar to what occurs in the penumbra after focal ischemia.…”

Section: Hypothermia Does Not Always Attenuate Stroke Even In the Labmentioning

confidence: 87%

General versus Specific Actions of Mild-Moderate Hypothermia in Attenuating Cerebral Ischemic Damage

Zhao

Steinberg

Sapolsky

2007

J Cereb Blood Flow Metab

153

135

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Mild or moderate hypothermia is generally thought to block all changes in signaling events that are detrimental to ischemic brain, including ATP depletion, glutamate release, Ca 2 + mobilization, anoxic depolarization, free radical generation, inflammation, blood-brain barrier permeability, necrotic, and apoptotic pathways. However, the effects and mechanisms of hypothermia are, in fact, variable. We emphasize that, even in the laboratory, hypothermic protection is limited. In certain models of permanent focal ischemia, hypothermia may not protect at all. In cases where hypothermia reduces infarct, some studies have overemphasized its ability to maintain cerebral blood flow and ATP levels, and to prevent anoxic depolarization, glutamate release during ischemia. Instead, hypothermia may protect against ischemia by regulating cascades that occur after reperfusion, including blood-brain barrier permeability and the changes in gene and protein expressions associated with necrotic and apoptotic pathways. Hypothermia not only blocks multiple damaging cascades after stroke, but also selectively upregulates some protective genes. However, most of these mechanisms are addressed in models with intraischemic hypothermia; much less information is available in models with postischemic hypothermia. Moreover, although it has been confirmed that mild hypothermia is clinically feasible for acute focal stroke treatment, no definite beneficial effect has been reported yet. This lack of clinical protection may result from suboptimal criteria for patient entrance into clinical trials. To facilitate clinical translation, future efforts in the laboratory should focus more on the protective mechanisms of postischemic hypothermia, as well as on the effects of sex, age and rewarming during reperfusion on hypothermic protection.

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Section: Hypothermia Does Not Always Attenuate Stroke Even In the Labmentioning

confidence: 87%

General versus Specific Actions of Mild-Moderate Hypothermia in Attenuating Cerebral Ischemic Damage

Zhao

Steinberg

Sapolsky

2007

J Cereb Blood Flow Metab

153

135

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“…In a canine study with induced mild hypothermia after normothermic cardiac arrest, hypothermia improved cerebral functional and morphologic outcome. However, if the induction of cooling was delayed for 15 min after ROSC, it did not improve functional outcome, although it may have mitigated histological tissue damage (Kuboyama et al 1993) The exact mechanism of induced therapeutic hypothermia is not clear. A reduction of cerebral oxygen consumption has been proposed (Hegnauer et al 1954) and other multifactorial physical and chemical mechanisms during and after low-flow induced ischaemia have also been postulated (Hypothermia after Cardiac Arrest Study Group 2002).…”

Section: Hypothermia After Cardiac Arrestmentioning

confidence: 98%

Out‐of‐hospital cardiac arrest: studies on aetiology, treatment and outcome

Virkkunen¹

2009

Acta Anaesthesiol Scand

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“…The use of moderate hypothermia after cardiac arrest was initially reported in the late 1950s and early 1960s [75,76]. There were no further investigations conducted on hypothermia as a resuscitative measure until the 1990s, when laboratory studies demonstrated the benefit of mild hypothermia [77][78][79][80]. These studies led to the preliminary clinical research on mild hypothermia.…”

Section: Therapeutic Hypothermiamentioning

confidence: 99%

Therapeutic heat and cold in cardiac rehabilitation

Habash¹,

Habash²,

El-Hage³

2017

Phys Ther Rehabil

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Background: Heart failure (HF) is an emerging epidemic that affects both sexes and all races. It is a complex clinical disease with symptoms caused from any structural or functional cardiac disorder, resulting in reduced longevity. HF is a weakening process that is difficult to treat and it exists in various conditions in which therapy needs to be customized. HF has reached epidemic scopes, mainly among the elderly, in whom it might be a reason for hospitalization. Common types of therapy for HF cases focus on pharmaceuticals and medical instrumentation. However, new approaches of patient-centered care that are based on complementary management strategies, improving quality of life without causing an economic worry or health side effects, are needed to decrease hospitalizations. Purpose: Epidemiology, public health, risk factors, HF management, and several therapeutic heat and cold modalities have been investigated and discussed. Results: Thermotherapy has a scientific evidence-based effect on the human body and can be used for treatment and rehabilitation of the heart. Conclusion: The progress made in bioheat transfer modelling and energy delivery techniques will have an impact on the development of effective therapeutic modalities that deliver controlled heat and/or cold to the human body.

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Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac arrest in dogs

Cited by 485 publications

References 0 publications

General versus Specific Actions of Mild-Moderate Hypothermia in Attenuating Cerebral Ischemic Damage

General versus Specific Actions of Mild-Moderate Hypothermia in Attenuating Cerebral Ischemic Damage

Out‐of‐hospital cardiac arrest: studies on aetiology, treatment and outcome

Therapeutic heat and cold in cardiac rehabilitation

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