Therapeutic Hypothermia Bryan Imayanagita 12/2/11 UCI T-RAP

Background Protective hypothermia Protective hypothermia Reduce ischemic injury to tissue Reduce ischemic injury to tissue Invasive and non invasive treatments Invasive and non invasive treatments Can reduce ischemic brain injuries Can reduce ischemic brain injuries

Categories of Treatment Hypothermia therapy for neonatal encephalopathy Hypothermia therapy for neonatal encephalopathy Cardiac arrest Cardiac arrest Stroke Stroke TBI/spinal cord injury TBI/spinal cord injury Neurogenic Fever Neurogenic Fever

Mechanism of Protection by Hypothermia Slowing of cellular metabolism (every 1 degree, metabolism slows by 5-7%) Slowing of cellular metabolism (every 1 degree, metabolism slows by 5-7%) Can act as a neuroprotectant Can act as a neuroprotectant Oxygen deprivation leads to imbalance in ion homeostasis (insufficient ATP) Oxygen deprivation leads to imbalance in ion homeostasis (insufficient ATP) Cell membrane made more impermeable to prevent flow of ions Cell membrane made more impermeable to prevent flow of ions

Invasive Treatment Invasive: cooling catheters Invasive: cooling catheters –NS through femoral vein –Control unit to bring down temperature (very accurate) – complications Bleeding Bleeding Infection Infection DVT DVT

Non Invasive Treatment Cold water blanket, torso vest, leg wraps Cold water blanket, torso vest, leg wraps Can overshoot or undershoot target temperature Can overshoot or undershoot target temperature

References Diringer, Michael. “Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system.” Crit Care Med. Vol. 32, No Diringer, Michael. “Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system.” Crit Care Med. Vol. 32, No Holzer, Michael. “Mild Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest.” New England Journal of Medicine. (2002) Vol. 346, No. 8. Holzer, Michael. “Mild Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest.” New England Journal of Medicine. (2002) Vol. 346, No. 8. Polderman, Kees H. “Application of therapeutic hypothermia in the ICU.” Intensive Care Med. (2004) 30: Polderman, Kees H. “Application of therapeutic hypothermia in the ICU.” Intensive Care Med. (2004) 30: Schwab, S. et al. “Moderate Hypothermia in the Treatment of Patients with Severe Middle Cerebral Artery Infarction.” American Heart Association. pg Schwab, S. et al. “Moderate Hypothermia in the Treatment of Patients with Severe Middle Cerebral Artery Infarction.” American Heart Association. pg Simosa, H. et al. “Increased Risk of Deep Venous Thrombosis with Endovascular Cooling in Patients with Traumatic Head Injury." Simosa, H. et al. “Increased Risk of Deep Venous Thrombosis with Endovascular Cooling in Patients with Traumatic Head Injury."