Therapeutic Therapeutic HypothermiaHypothermia

Bryan ImayanagitaBryan Imayanagita

12/2/1112/2/11

UCI T-RAPUCI T-RAP

BackgroundBackground

Protective hypothermiaProtective hypothermia Reduce ischemic injury to tissueReduce ischemic injury to tissue Invasive and non invasive Invasive and non invasive

treatmentstreatments Can reduce ischemic brain Can reduce ischemic brain

injuriesinjuries

Categories of Categories of TreatmentTreatment

Hypothermia therapy for neonatal Hypothermia therapy for neonatal encephalopathy encephalopathy

Cardiac arrestCardiac arrest StrokeStroke TBI/spinal cord injuryTBI/spinal cord injury Neurogenic FeverNeurogenic Fever

Mechanism of Mechanism of Protection by Protection by HypothermiaHypothermia

Slowing of cellular metabolism (every Slowing of cellular metabolism (every 1 degree, metabolism slows by 5-7%)1 degree, metabolism slows by 5-7%)

Can act as a neuroprotectantCan act as a neuroprotectant Oxygen deprivation leads to imbalance Oxygen deprivation leads to imbalance

in ion homeostasis (insufficient ATP)in ion homeostasis (insufficient ATP) Cell membrane made more Cell membrane made more

impermeable to prevent flow of ionsimpermeable to prevent flow of ions

Invasive TreatmentInvasive Treatment

Invasive: cooling catheters Invasive: cooling catheters – NS through femoral veinNS through femoral vein– Control unit to bring down Control unit to bring down

temperature (very accurate)temperature (very accurate)– complicationscomplications

BleedingBleeding InfectionInfection DVTDVT

Non Invasive Non Invasive TreatmentTreatment

Cold water blanket, torso vest, leg Cold water blanket, torso vest, leg wrapswraps

Can overshoot or undershoot Can overshoot or undershoot target temperaturetarget temperature

ReferencesReferences

Diringer, Michael. “Treatment of fever in the neurologic Diringer, Michael. “Treatment of fever in the neurologic intensive care unit with a catheter-based heat intensive care unit with a catheter-based heat exchange system.” Crit Care Med. Vol. 32, No. 2. 2004. exchange system.” Crit Care Med. Vol. 32, No. 2. 2004.

Holzer, Michael. “Mild Hypothermia to Improve the Holzer, Michael. “Mild Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest.” New Neurologic Outcome After Cardiac Arrest.” New England Journal of Medicine. (2002) Vol. 346, No. 8. England Journal of Medicine. (2002) Vol. 346, No. 8.

Polderman, Kees H. “Application of therapeutic Polderman, Kees H. “Application of therapeutic hypothermia in the ICU.” Intensive Care Med. (2004) hypothermia in the ICU.” Intensive Care Med. (2004) 30:556-575. 30:556-575.

Schwab, S. et al. “Moderate Hypothermia in the Schwab, S. et al. “Moderate Hypothermia in the Treatment of Patients with Severe Middle Cerebral Treatment of Patients with Severe Middle Cerebral Artery Infarction.” American Heart Association. pg. Artery Infarction.” American Heart Association. pg. 2461-2466 2461-2466

Simosa, H. et al. “Increased Risk of Deep Venous Simosa, H. et al. “Increased Risk of Deep Venous Thrombosis with Endovascular Cooling in Patients with Thrombosis with Endovascular Cooling in Patients with Traumatic Head Injury." Traumatic Head Injury."