Hypothermia as a Neuroprotectant for Neurorehabilitation Eligible Patients: State of the Art Review and Update
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Abstract
Applying therapeutic hypothermia (TH) for the purposes of neuroprotection, originally termed “hibernation,” started nearly 100 years ago. As advances in the medical and surgical management of patients with neurotrauma has increased survivability and minimized primary damage, significant research has been directed at identifying neuroprotective mechanisms that might mitigate the secondary damage which leads to neurological worsening and impedes recovery. As therapeutic hypothermia cooling systems have improved to the point where it is practical and safe for general application, interest in providing such treatment in conditions such as spinal cord injury, traumatic brain injury, stroke, and cardiac arrest has increased. This manuscript will review the mechanisms by which therapeutic hypothermia mitigates secondary neurological injury, the clinical scenarios where therapeutic hypothermia is being applied via Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI), and Stroke (CVA), and review published studies utilizing therapeutic hypothermia for central nervous system neuroprotection in translational studies.
Keywords:
Spinal Cord Injury, Hypothermia, Neuroprotection, ASIA score, Trauma, Methylprednisolone, Stroke, Traumatic Brain Injury, TBI
Article Details
How to Cite
DALAL, Kevin L. et al.
Hypothermia as a Neuroprotectant for Neurorehabilitation Eligible Patients: State of the Art Review and Update.
Medical Research Archives, [S.l.], v. 12, n. 3, mar. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5202>. Date accessed: 30 apr. 2024.
doi: https://doi.org/10.18103/mra.v12i3.5202.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Henderson AR Temple F. Uncomfortable crusader and Harbinger of human refrigeration 1895-1963. 1963;J Neurosurg 20:627-634.
3. Zdravev P. Treatment of cerebral hernia following surgery of an otogenous brain abscess. Les Annales d'oto-laryngologie. 1951;68:201-205.
4. Busto R, Dietrich WD, Globus MY, Ginsberg MD. The importance of brain temperature in cerebral ischemic injury. Stroke. 1989;20:1113-1114.
5. Metz C, Holzschuh M, Bein T, Woertgen C, Frey A, Frey I, Taeger K, Brawanski A. Moderate hypothermia in patients with severe head injury: cerebral and extracerebral effects. J Neurosurg. 1996;85:533-541.
6. Clifton GL, Allen S, Barrodale P, Plenger P, Berry J, Koch S, Fletcher J, Hayes RL, Choi SC. A phase II study of moderate hypothermia in severe brain injury. J Neurotrauma. 1993;10:263-271; discussion 273.
7. Faridar A, Bershad EM, Emiru T, Iaizzo PA, Suarez JI, Divani AA. Therapeutic hypothermia in stroke and traumatic brain injury. Frontiers in Neurology. 2011;2:80
8. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109:318-338.
9. Jessen K. An assessment of human regulatory nonshivering thermogenesis. Acta anaesthesiologica Scandinavica. 1980;4:138-143.
10. Yenari M, Wijman C, Steinberg G. Effects of hypothermia on cerebral metabolism, blood flow, and autoregulation. In: Mayer S, Sessler D (eds) Therapeutic hypothermia. Marcel Dekker, New York. 2008;141-178
11. Varon J, Acosta P. Therapeutic hypothermia: past, present, and future. Chest. 2008;133:1267-1274.
12. Martinez-Arizala A, Green B (1992) Hypothermia in spinal cord injury. J Neurotrauma 9:S497-S505
13. Yu C, Jimenez O, Marcillo A, Weider B, Bangerter K, Dietrich W, Castro S, Yezierski R. Beneficial effects of modest systemic hypothermia on locomotor function and histopathological damage following contusion-induced spinal cord injury in rats. J Neurosurg (Spine). 2000;93: 1 Suppl 85–93
14. Chatzipantelli K, Yanagawa Y, Marcillo A, Kraydieh S, Dietrich W (2000) Posttraumatic hypothermia reduces polymorphonuclear leukocyte accumulation following spinal cord injury in rats. J Neurotrauma 17:321-332
15. Westergren H, Farooque M, Olsson Y, Holtz A (2000) Motor function changes in the rat following severe spinal cord injury. Does treatment with moderate systemic hypothermia improve functional outcome? Acta Neurochir (Wien) 142:567-573
16. Marsala M, Sorkin L, Yaksh T. Transient spinal ischemia in rat: Characterization of spinal cord blood flow, extracellular amino acid release, and concurrent histopathological damage. J Cereb Blood Flow Metab. 1994;14(4):604-14. Doi:10.1038/jcbfm https://pubmed.ncbi.nlm.nih.gov/8014207/
17. You JS, Kim JY, Yenari MA. Therapeutic hypothermia for stroke: Unique challenges at the bedside. Front Neurol. 2022 Oct 3;13:951586. Doi: 10.3389/fneur.2022.951586. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9575992/
18. Bernard SA, Mac CJB, Buist M. Experience with prolonged induced hypothermia in severe head injury. Critical Care. 1999;3:167-172.
19. Sunde K, Pytte M, Jacobsen D, Mangschau A, Jensen LP, Smedsrud C, Draegni T, Steen PA. Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 2007;73:29-39.
20. Seule M, Muroi C, Sikorski C, Hugelshofer M, Winkler K, Keller E. Therapeutic hypothermia reduces middle cerebral artery flow velocity in patients with severe aneurysmal subarachnoid hemorrhage. Neurocritical care. 2014;20(2):255-62. Doi: 10.1007/s12028-013-9927-x.
21. Todd MM, Hindman BJ, Clarke WR, Torner JC (2005) Mild intraoperative hypothermia during surgery for intracranial aneurysm. N Engl J Med 352:135-145
22. Sherman AL, Wang MY. Hypothermia as a clinical neuroprotectant. Phys Med Rehabil Clin N Am. 2014 Aug;25(3):519-29, vii. Doi: 10.1016/j.pmr.2014.04.003. https://pubmed.ncbi.nlm.nih.gov/25064786/.
23. Vedantam A, Levi AD. Hypothermia for Acute Spinal Cord Injury. Neurosurg Clin N Am. 2021 Jul;32(3):377-387.
Doi: 10.1016/j.nec.2021.03.009
https://pubmed.ncbi.nlm.nih.gov/34053725/
24. Polderman KH, Callaghan J. Equipment review: cooling catheters to induce therapeutic hypothermia? Crit Care. 2006;10(6):234. Doi: 10.1186/cc5023 https://pubmed.ncbi.nlm.nih.gov/17096865/
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