Hypothermia Used in Medical Applications for Brain and Spinal Cord Injury Patients

Zhu, Liang

doi:10.1007/978-3-319-96445-4_16

Cited by 10 publications

(7 citation statements)

References 166 publications

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“…The main purpose of TH is to improve the prognosis of patients. TH has been applied in clinical auxiliary treatment since being re-valued by scholars in the 1990s (26)(27)(28). Many studies have suggested that TH could improve the neurological prognosis and reduce adverse reactions in children with TBI.…”

Section: Discussionmentioning

confidence: 99%

Effects of therapeutic hypothermia on the safety of children with severe traumatic brain injury: a systematic review and meta-analysis

et al. 2022

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Background: Therapeutic hypothermia (TH) is effective to treat adult traumatic brain injury (TBI), but there is still controversy about its safety to treat the children with severe TBI.Methods: Clinical studies on TH in children with severe TBI from January 2000 to September 2020 were screened in PubMed, Web of Science, Embase, Cochrane Library, Nature, NCKI, and Wanfang online databases. Data were meta-analyzed by Rev Man 5.3. Differences in mortality, adverse outcomes, duration of Pediatric Intensive Care Unit (PICU), incidence of infection, and incidence of arrhythmia were compared between experimental group and control group. The heterogeneity of the results was evaluated by chi-square test and I 2 test in Rev Man 5.3, and publication bias was evaluated by funnel plot.Results: Five articles were included, including 421 children. Cochrane evaluation was B grade or above, and Jadad scale score was over three points. The overall mortality between two groups showed great difference

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Section: Discussionmentioning

confidence: 99%

Effects of therapeutic hypothermia on the safety of children with severe traumatic brain injury: a systematic review and meta-analysis

et al. 2022

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“…In comparison, we started hypothermia later on, cooled within 20 min (apart from the first patient) to 33 °C for 12 hours and rewarmed slowly at 0.5 °C/h. It has been suggested that slower rewarming (<0.5 °C/h) might be more beneficial 25 . We do not know whether earlier onset hypothermia or more prolonged hypothermia or slower rewarming might have shown beneficial effects on ISP, SCPP, cord metabolism and cord inflammation.…”

Section: Discussionmentioning

confidence: 99%

Effects of local hypothermia–rewarming on physiology, metabolism and inflammation of acutely injured human spinal cord

Gallagher

Hogg

Kearney

et al. 2020

Sci Rep

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In five patients with acute, severe thoracic traumatic spinal cord injuries (TSCIs), American spinal injuries association Impairment Scale (AIS) grades A-C, we induced cord hypothermia (33 °C) then rewarming (37 °C). A pressure probe and a microdialysis catheter were placed intradurally at the injury site to monitor intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), tissue metabolism and inflammation. Cord hypothermia-rewarming, applied to awake patients, did not cause discomfort or neurological deterioration. Cooling did not affect cord physiology (ISP, SCPP), but markedly altered cord metabolism (increased glucose, lactate, lactate/pyruvate ratio (LPR), glutamate; decreased glycerol) and markedly reduced cord inflammation (reduced IL1β, IL8, MCP, MIP1α, MIP1β). Compared with pre-cooling baseline, rewarming was associated with significantly worse cord physiology (increased ICP, decreased SCPP), cord metabolism (increased lactate, LPR; decreased glucose, glycerol) and cord inflammation (increased IL1β, IL8, IL4, IL10, MCP, MIP1α). The study was terminated because three patients developed delayed wound infections. At 18-months, two patients improved and three stayed the same. We conclude that, after TSCI, hypothermia is potentially beneficial by reducing cord inflammation, though after rewarming these benefits are lost due to increases in cord swelling, ischemia and inflammation. We thus urge caution when using hypothermia-rewarming therapeutically in TSCI. Hypothermia is being investigated as a potential therapy for traumatic brain injury (TBI) 1 and traumatic spinal cord injury (TSCI) 2 based on compelling evidence from several laboratories and animal species that hypothermia is neuroprotective. In animal models of TBI, hypothermia has been shown to target many pathological processes including reducing the metabolic rate, inflammation, edema, oxidative stress, excitotoxicity, electrolyte imbalance as well as apoptotic and necrotic cell death in vulnerable tissue 3-8. Despite the encouraging findings of animal studies, randomized controlled human trials have failed to show functional benefit of hypothermia in TBI patients 1,9,10. Therapeutic hypothermia is also beneficial in animal models of TSCI: rodent models of TSCI show improved histological and functional outcomes after hypothermia 11,12. Small, non-randomized studies of TSCI patients also suggest improved functional outcomes after local 13,14 or systemic hypothermia 2,15. To date, there are no published randomized controlled trials of hypothermia for TSCI. Despite the wide interest in therapeutic hypothermia for CNS injuries, there is paucity of mechanistic data from humans regarding the effect of hypothermia on the injury site. In TSCI patients, the effect of cooling and rewarming on cord swelling, metabolism and inflammation are unknown. It is thus unclear if hypothermia and

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“…Zhu [13] has reviewed beautifully various engineering technologies that have been applied previously for cooling of the brain or spinal cord to prevent or limit injury. These include skin surface cooling, instillation of a cold perfusate (chilled saline) directly into the bloodstream (whole body cooling), direct blood cooling (intravascular catheter), localized direct ice-pad cooling of the spinal cord or brain during open spinal cord or brain surgical procedures, and nasopharyngeal cooling (by cold air or by a nasal cooling catheter).…”

Section: Part B Spinal Cord Protection In Descending/thoracoabdominal...mentioning

confidence: 99%

A Cardiac Surgical Perspective on Hypothermia for Protection of Neural Tissues

Elefteriades¹,

Simmons²,

Ziganshin³

2022

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Background: In clinical and basic science medicine, we often isolate ourselves in silos, unaware of developments in other related disciplines. Our team has had substantial experience, both in the operating room and in the laboratory, with protecting the brain and the spinal cord via hypothermia. Herein, we briefly share this experience with our colleagues in Neurology, eager for comments and advice from the neurologic perspective. Methods: 1) Clinical brain protection via deep hypothermic circulatory arrest (DHCA) for surgery of the aortic arch. For aortic arch replacement (performed for aortic arch aneurysm or aortic dissection), the aortic arch must be opened and native perfusion stopped. We have decades of experience in many hundreds of patients with this technique. This experience is reviewed. 2) Experimental protection of the spinal cord via cooling. We review our laboratory experience with a novel, recirculating cooling catheter for the vulnerable spinal cord. 3) Experimental protection of the brain via an intraventricular cooling catheter.

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Hypothermia Used in Medical Applications for Brain and Spinal Cord Injury Patients

Cited by 10 publications

References 166 publications

Effects of therapeutic hypothermia on the safety of children with severe traumatic brain injury: a systematic review and meta-analysis

Effects of therapeutic hypothermia on the safety of children with severe traumatic brain injury: a systematic review and meta-analysis

Effects of local hypothermia–rewarming on physiology, metabolism and inflammation of acutely injured human spinal cord

A Cardiac Surgical Perspective on Hypothermia for Protection of Neural Tissues

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