Current Advances in the Use of Therapeutic Hypothermia.

Abstract

Temperature management and therapeutic hypothermia is being investigated in stroke, subarachnoid hemorrhage, myocardial infarction, and neonatal encephalopathy. Previous clinical studies have provided support for the use of hypothermia in these clinical conditions, and new studies are currently underway to establish safety and efficacy of this therapeutic intervention. Thus, this particular session brought together experts in the field of therapeutic hypothermia to discuss its use in several important patient populations. Dr. Neeraj Badjatia from the University of Maryland School of Medicine discussed antishivering strategies targeting stroke and subarachnoid hemorrhage. This lecture emphasized thermoregulatory systems and systematic approaches toward shiver control during cooling in patients with acute stroke. Various pharmacological strategies are currently used for shiver control, including drug combinations and counterwarming approaches. Dr. Christopher J. White of the Ochsner Medical Center emphasized the use of hypothermia in myocardial infarction. Myocardial infarction is an extremely important clinical problem, and the use of hypothermia to reduce ischemic injury and reperfusion-injury is currently being assessed in both preclinical and clinical studies. Previous clinical studies including a prospective randomized trial reported that postreperfusion cooling provided no significant improvement. However, recent investigations are concentrating on hypothermia treatment initiated before reperfusion, and these have been very promising. Dr. Abbot Laptook, Brown University, updated the attendees on therapeutic cooling and neonatal hypoxic ischemic encephalopathy. Results from published multicenter trials have emphasized the benefits of therapeutic hypothermia in newborn hypoxic ischemic encephalopathy patients, and issues regarding implementation of hypothermia on transport to hospitals are being evaluated along with combination approaches. Dr. Markus Foedisch from Bonn, Germany, discussed the use of brain damage markers to determine how best to utilize hypothermia after cardiac arrest. Dr. Foedisch updated the attendees regarding the cool brain register as well as the effects of cooling on available biomarkers, including neuron-specific enolase and S100B. This session had an extensive question-and-answer exchange and provided new information regarding the advances being made in the use of hypothermia in these clinical conditions.