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Stamatios Giannakis, Maria Ruhfus, Mario Rüdiger, , The German Neonatal Hypothermia Network, German Neonatal Hypothermia Network
Published: 20 August 2019
by Wiley
Acta Paediatrica, Volume 109, pp 200-201; doi:10.1111/apa.14979

Abstract:
Perinatal asphyxia is a major contributor to neonatal death in term born infants. Hypoxic‐ischaemic encephalopathy (HIE) is the most important asphyxia‐related complication affecting the newborn brain and causes 23% of neonatal deaths worldwide. Severe disabilities, such as cerebral palsy, seizures or mental retardation, occur in 30% of newborn infants with moderate HIE and 90% with severe HIE. Therapeutic hypothermia is the only established, standardised treatment and its efficacy has been proven by many randomised clinical trials. This article is protected by copyright. All rights reserved.
, Nagoya Therapeutic Hypothermia Study Group, M. Takayasu, S. Inao, J. Yoshida
Intracerebral Hemorrhage Research, Volume 95, pp 269-272; doi:10.1007/3-211-32318-x_55

The publisher has not yet granted permission to display this abstract.
, , Hypothermia After Cardiac Arrest (H
Expert Review of Cardiovascular Therapy, Volume 1, pp 317-325; doi:10.1586/14779072.1.2.317

The publisher has not yet granted permission to display this abstract.
Sarah Meaney, Siobhan Horkan, Julie Mc Ginley, Paul Corcoran, Richard Green, John Murphy, Neonatal Therapeutic Hypothermia Working Group
Published: 12 June 2019
by BMJ
Abstracts, Volume 104; doi:10.1136/archdischild-2019-epa.302

Abstract:
Before or during birth, a small number of infants experience reduced oxygen or blood supply. After birth, some of these infants will show abnormal neurological behaviour, diagnosed as hypoxic-ischemic encephalopathy (HIE). The consequences of HIE for the infant, their family and the wider society are considerable. Therapeutic hypothermia (TH) is a therapy which involves cooling an infant to a targeted temperature below an infants’ normal core body temperature and is now the standard treatment for term infants (babies born after 36 completed weeks of gestation) with moderate to severe HIE. Research has demonstrated TH reduces the rate of death, severe disability and lifelong cerebral palsy for infants born with HIE. A standardised dataset was developed to collect detailed clinical data on the maternal, infant and clinical characteristics associated with TH. In Ireland, TH is administered in the four tertiary maternity hospitals, whereby infants born in other hospitals requiring this treatment are transferred to one of these four tertiary hospitals. Anonymised data were collected on site in the 19 maternity units/hospitals and neonatal intensive care units or special care baby units (NICU/SCBU) in the Republic of Ireland on all infants requiring TH between 1 January 2016 and 31 December 2017. Over the two year period, 140 infants required TH which suggests that one in 900 infants born in Ireland during 2016/2017 required TH. Nulliparous women accounted for 60% of the TH cohort (n=84). Of the women whose infants underwent TH, 18.6% (n=26) experienced maternal pyrexia during labour and 10% of women had a prolonged rupture of membranes (n=14). Less than 2% of mothers had an elective caesarean section. At one minute after birth 79.7%; of infants had an Apgar score between zero and three (n=110). Almost all infants required resuscitation at birth (95%; n=133 of 140), with 59.3% of infants needing intubation (n=83). Over the two year period, 60% (n=84) were born in a tertiary hospital with 40% (n=56) of infants requiring transfer from a regional or local hospital. The survival rate for the TH cohort was 88%, as 17 of the 140 infants died. The findings of this audit illustrate the logistical challenges faced with the delivery of a high acuity, uncommon treatment that has to be delivered on short notice. These findings also highlighted that there was an overrepresentation of complications preceding and during the delivery of the infants requiring TH.
, , Tom Owen, R. Markham, D. Sebastian, N. Greenwood, B. Foëx, P. Ferris, G. Hardy, A. Quinn, et al.
Journal of the Intensive Care Society, Volume 13, pp 102-106; doi:10.1177/175114371201300205

Abstract:
Therapeutic hypothermia is used to reduce mortality and morbidity following cardiac arrest. It is increasingly being used to cover a variety of indications including primary out-of-hospital ventricular fibrillation (VF) and non-VF cardiac arrests, in-hospital cardiac arrests and cardiac arrests of secondary cause. We have studied indications, techniques, efficiency, outcomes and complications of post-cardiac arrest cooling processes used in routine clinical practice in intensive care units in the north west of England. Survival at hospital discharge post-VF arrest was 53% in this multicentre cohort and all survivors at discharge had good or fair neurological recovery. This study confirms that our cooling and rewarming practices are effective and similar to those described in current literature, and meet standards set by the International Liaison Committee for Resuscitation (ILCOR).
, on behalf of the Brain Hypothermia (B-HYPO) Study Group in Japan, , , , , ,
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Volume 25, pp 1-8; doi:10.1186/s13049-017-0465-y

Abstract:
Coagulopathy in traumatic brain injury (TBI) has been associated with poor neurological outcomes and higher in-hospital mortality. In general principle of trauma management, hypothermia should be prevented as it directly worsens coagulopathy. Therefore, we examined the safety of mild therapeutic hypothermia (MTH) in patients with coagulopathy following severe TBI. We re-evaluated the brain hypothermia (B-HYPO) study data based on coagulopathy and compared the Glasgow Outcome Scale scores and survival rates at 6 months using per protocol analyses. Coagulopathy was defined as an activated partial thromboplastin time (APTT) > 60 s and/or fibrin/fibrinogen degradation product levels (FDP) > 90 μg/mL on admission. Baseline characteristics, coagulation parameters, and outcomes were compared between the control and MTH groups with or without coagulopathy. In patients with coagulopathy, 12 patients were allocated to the control group (35.5–37.0 °C) and 20 patients to the MTH group (32–34 °C). In patients without coagulopathy, 28 were allocated to the control group and 59 patients were allocated to the MTH group. In patients with coagulopathy, favorable neurological outcomes and survival rates were comparable between the control and MTH groups (33.3% vs. 35.0%, P = 1.00; 50.0% vs. 60.0%, P = 0.72) with no difference in complication rates. On admission, no significant differences in APTT or FDP levels were observed between the two groups; however, APTT was significantly prolonged in the MTH group compared to the control group on day 3. Based on our study, MTH did not seem to negatively affect the outcomes in patients with coagulopathy following severe TBI on admission; therefore, the present study indicates that MTH may be applicable even in patients with severe TBI and coagulopathy. Our study suggests that in comparison to control, MTH does not worsen the outcome of patients with coagulopathy following severe TBI. UMIN-CTR, No. C000000231, Registered 13 September 2005.
H. Bart Van Der Worp, , Rainer Kollmar, European Stroke Res Network for the European Stroke Research Network for Hypothermia (EuroHYP)
British Journal of Pharmacology, Volume 30, pp 1079-1093; doi:10.1038/jcbfm.2010.44

Abstract:
Therapeutic hypothermia is a means of neuroprotection well established in the management of acute ischemic brain injuries such as anoxic encephalopathy after cardiac arrest and perinatal asphyxia. As such, it is the only neuroprotective strategy for which there is robust evidence for efficacy. Although there is overwhelming evidence from animal studies that cooling also improves outcome after focal cerebral ischemia, this has not been adequately tested in patients with acute ischemic stroke. There are still some uncertainties about crucial factors relating to the delivery of hypothermia, and the resolution of these would allow improvements in the design of phase III studies in these patients and improvements in the prospects for successful translation. In this study, we discuss critical issues relating first to the targets for therapy including the optimal depth and duration of cooling, second to practical issues including the methods of cooling and the management of shivering, and finally, of factors relating to the design of clinical trials. Consideration of these factors should inform the development of strategies to establish beyond doubt the place of hypothermia in the management of acute ischemic stroke.
, J. Hovdenes, F. Nilsson, S. Rubertsson, P. Stammet, K. Sunde, F. Valsson, M. Wanscher, H. Friberg, For The Hypothermia Network
Published: 1 August 2009
by Wiley
Acta Anaesthesiologica Scandinavica, Volume 53, pp 926-934; doi:10.1111/j.1399-6576.2009.02021.x

The publisher has not yet granted permission to display this abstract.
Byung Kook Lee, Kyu Nam Park, Gu Hyun Kang, Kyung Hwan Kim, Giwoon Kim, Won Young Kim, Jin Hong Min, Yooseok Park, Jung Bae Park, Gil Joon Suh, et al.
Clinical and Experimental Emergency Medicine, Volume 1, pp 19-27; doi:10.15441/ceem.14.007

Abstract:
Therapeutic hypothermia (TH) has become the standard strategy for reducing brain damage in the postresuscitation period. The aim of this study was to investigate current TH performance and outcomes in out-of-hospital cardiac arrest (OHCA) survivors using data from the Korean Hypothermia Network (KORHN) registry. We used the KORHN registry, a web-based multicenter registry that includes 24 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TH between 2007 and 2012 were included. The primary outcomes were neurological outcome at hospital discharge and in-hospital mortality. The secondary outcomes were TH performance and adverse events during TH. A total of 930 patients were included, of whom 556 (59.8%) survived to discharge and 249 (26.8%) were discharged with good neurologic outcomes. The median time from return of spontaneous circulation (ROSC) to the start of TH was 101 minutes (interquartile range [IQR], 46 to 200 minutes). The induction, maintenance, and rewarming durations were 150 minutes (IQR, 80 to 267 minutes), 1,440 minutes (IQR, 1,290 to 1,440 minutes), and 708 minutes (IQR, 420 to 900 minutes), respectively. The time from the ROSC to coronary angiography was 1,045 hours (IQR, 121 to 12,051 hours). Hyperglycemia (46.3%) was the most frequent adverse event. More than one-quarter of the OHCA survivors (26.8%) were discharged with good neurologic outcomes. TH performance was appropriately managed in terms of the factors related to its timing, including cooling start time and rewarming duration.
, Susumu Yamashita, Seigo Nagao, Nariyuki Hayashi, Yasuo Ohashi, on behalf of the Brain-Hypothermia (B-HYPO) Study Group
Published: 1 April 2015
Journal of Neurotrauma, Volume 32, pp 422-429; doi:10.1089/neu.2013.3197

The publisher has not yet granted permission to display this abstract.
, Yasuhiro Kuroda, Kenya Kawakita, Susumu Yamashita, Yasutaka Oda, Kenji Dohi, Tsuyoshi Maekawa, on behalf of the Brain Hypothermia (B-HYPO) Study Group in Japan
Journal of Neurotrauma, Volume 33, pp 1047-1053; doi:10.1089/neu.2015.4033

Abstract:
In our prospective, multi-center, randomized controlled trial (RCT)—the Brain Hypothermia (B-HYPO) study—we could not show any difference on neurological outcomes in patients probably because of the heterogeneity in the severity of their traumatic condition. We therefore aimed to clarify and compare the effectiveness of the two therapeutic temperature management regimens in severe (Abbreviated Injury Scale [AIS] 3–4) or critical trauma patients (AIS 5). In the present post hoc B-HYPO study, we re-evaluated data based on the severity of trauma as AIS 3–4 or AIS 5 and compared Glasgow Outcome Scale score and mortality at 6 months by per-protocol analyses. Consequently, 135 patients were enrolled. Finally, 129 patients, that is, 47 and 31 patients with AIS 3–4 and 36 and 15 patients with AIS 5 were allocated to the mild therapeutic hypothermia (MTH) and fever control groups, respectively. No significant intergroup differences were observed with regard to age, gender, scores on head computed tomography (CT) scans, and surgical operation for traumatic brain injury (TBI), except for Injury Severity Score (ISS) in AIS 5. The fever control group demonstrated a significant reduction of TBI-related mortality compared with the MTH group (9.7% vs. 34.0%, p = 0.02) and an increase of favorable neurological outcomes (64.5% vs. 51.1%, p = 0.26) in patients with AIS 3–4, although the latter was not statistically significant. There was no difference in mortality or favorable outcome in patients with AIS 5. Fever control may be considered instead of MTH in patients with TBI (AIS 3–4).
Barbara Kabon, Andreas Bacher, Christian K Spiss
Best Practice & Research Clinical Anaesthesiology, Volume 17

The publisher has not yet granted permission to display this abstract.
, Yuchuan Ding
Published: 1 January 2020
Brain Circulation, Volume 6, pp 139-144; doi:10.4103/bc.bc_31_20

Abstract:
Stroke is one of the leading causes of mortality and morbidity worldwide, and yet, current treatment is limited to thrombolysis through either t-PA or mechanical thrombectomy. While therapeutic hypothermia has been adopted in clinical contexts such as neuroprotection after cardiac resuscitation and neonatal hypoxic-ischemic encephalitis, it is yet to be used in the context of ischemic stroke. The lack of ameliorative effect in ischemic stroke patients may be tied to the delayed cooling induction onset. In the trials where the cooling was initiated with significant delay (mostly systemic cooling methods), minimal benefit was observed; on the other hand, when cooling was initiated very early (mostly selective cooling methods), there was significant efficacy. Another timing factor that may play a role in amelioration may be the onset of cooling relative to thrombolysis therapy. Current understanding of the pathophysiology of acute ischemic injury and ischemia-reperfusion injury suggests that hypothermia before thrombolysis may be the most beneficial compared to cooling initiation during or after reperfusion. As many of the systemic cooling methods tend to require longer induction periods and extensive, separate procedures from thrombolysis therapy, they are generally delayed to hours after recanalization. On the other hand, selective cooling was generally performed simultaneously to thrombolysis therapy. As we conduct and design therapeutic hypothermia trials for stroke patients, the key to their efficacy may lie in quick and early cooling induction, both respective to the symptom onset and thrombolysis therapy.
Critical Care, Volume 17, pp 318-7; doi:10.1186/cc12559

Abstract:
Although therapeutic hypothermia could serve as a potential therapeutic strategy for treatment of traumatic hemorrhagic shock, significant controversy exists regarding its safety and feasibility. The current resuscitation strategy in traumatic hemorrhagic shock may also require updating. In this article, we have carried out an extensive literature search in this field and propose an initial algorithm for use of therapeutic hypothermia in traumatic hemorrhagic shock. This work lays essential groundwork for future investigations in this field.
, M Takayasu, , J Yoshida
Published: 1 January 2005
Acta Neurochirurgica Supplement, Volume 95

The publisher has not yet granted permission to display this abstract.
Teresa Camp-Rogers, Geoff Murphy, Anne Dean, Kyle Gunnerson, Darrin Rossler, Michael C. Kurz
The American Journal of Emergency Medicine, Volume 30, pp 387.e5-387.e7; doi:10.1016/j.ajem.2010.11.036

Comment
V. Sharma
Published: 9 December 2009
by Wiley
Anaesthesia, Volume 65, pp 753-754; doi:10.1111/j.1365-2044.2010.06396.x

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Volume 17, pp 53-53; doi:10.1186/1757-7241-17-53

Abstract:
Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting.
David Aggen, Meena Azeem, Shahniwaz Labana, Roman Barraza, Cesar Hidalgo, Sarwan Kumar, Ahmad Ghabsha
Published: 1 October 2015
Chest, Volume 148, pp 241A-241A; doi:10.1378/chest.2229751

The publisher has not yet granted permission to display this abstract.
Hing-Yu So
Korean Journal of Anesthesiology, Volume 59, pp 299-304; doi:10.4097/kjae.2010.59.5.299

Abstract:
Pioneer works on therapeutic hypothermia (TH) half a century ago already showed promising results but clinical application was limited by a lack of understanding of the underlying pathophysiology, lack of reliable method for temperature control and lack of intensive care facilities to deal with possible complications. More recently, 2 studies in 2002 supported the application of moderate TH (32.0-34.0℃) in post-cardiac arrest patients. Although the studies included only patients suffering from out-of-hospital VF, many ICUs world-wide are applying the therapy to all post-cardiac arrest patients irrespective of site or presenting rhythm. While primary coagulopathy and cardiogenic shock are usually stated as relative contraindications, evidences are accumulating to support the application of TH in patients with cardiogenic shock. TH can be divided into 4 phases: Induction, maintenance, de-cooling and normothermia. Induction is usually achieved by infusion of cold isotonic fluid. The precautions included avoidance of over-cooling, hypokalaemia, hyperglycaemia, and shivering. TH can be maintained by many different methods, varying in their level of invasiveness, cost and effectiveness. Issues including changes in pharmacokinetics and haemodynamics, and susceptibility to infection need to the addressed. The optimal duration of maintenance is unknown but the usual practice is 12-24 hours. De-cooling and rewarming is especially challenging because complications can be serious if temperature rise by more than 1℃ every 3-5 hours. Life-theatening hyperkalaemia can occur especially if patient suffers from renal insufficiency. Fever is a frequent complication either due to infection or post-cardiac arrest syndrome but patient must be kept normothermic for 72 hours.
Published: 5 July 2011
Emergency Nurse, Volume 19, pp 11-11; doi:10.7748/en.19.4.11.s8

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Padmaja Durga
Global Journal of Anesthesiology, Volume 2, pp 025-035; doi:10.17352/2455-3476.000013

Abstract:
Global Journal of Anesthesiology is a peer reviewed, an open access, international, academic and elevated scope journal...
Comment
Salvatore Alongi, Federico Polli, Italian Cooling Experience Study Group
Published: 1 February 2013
Resuscitation, Volume 84; doi:10.1016/j.resuscitation.2012.10.026

S L Edwards
Published: 1 March 1999
Professional nurse (London, England), Volume 14

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Current Treatment Options in Neurology, Volume 14, pp 541-548; doi:10.1007/s11940-012-0201-x

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Christian S. Yacono, Stephanie Eider
Journal of the American Academy of Physician Assistants, Volume 30, pp 29-34; doi:10.1097/01.jaa.0000511792.75301.73

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Comment
Published: 1 August 2012
Resuscitation, Volume 83, pp 930-931; doi:10.1016/j.resuscitation.2012.05.019

Comment
Narat Srivali, Saeed Ahmed, Wisit Cheungpasitporn, Daych Chongnarungsin
The American Journal of Emergency Medicine, Volume 30; doi:10.1016/j.ajem.2012.03.006

Comment
Stephan A Padosch, Karl B Kern,
New England Journal of Medicine, Volume 347, pp 63-65; doi:10.1056/nejm200207043470114

Comment
Stephen A Bernard
Published: 1 November 2004
by AMPCo
Medical Journal of Australia, Volume 181, pp 468-9; doi:10.5694/j.1326-5377.2004.tb06399.x

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Seminars in Fetal and Neonatal Medicine, Volume 15; doi:10.1016/j.siny.2010.05.002

, J. Nee, J. C. Schefold, A. Krueger, C. Storm
Published: 1 June 2010
by BMJ
Emergency Medicine Journal, Volume 28, pp 483-485; doi:10.1136/emj.2009.090464

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, Derk Krieger, Midori Yenari, W. Dalton Dietrich
Published: 1 February 2006
by Wiley
International Journal of Stroke, Volume 1, pp 9-19; doi:10.1111/j.1747-4949.2005.00011.x

The publisher has not yet granted permission to display this abstract.
Therapeutic Hypothermia in Brain Injury; doi:10.5772/49374

Abstract:
Therapeutic Hypothermia for Cardiac Arrest | InTechOpen, Published on: 2013-01-30. Authors: Farid Sadaka
Eelco F. M. Wijdicks
The Comatose Patient pp 561-564; doi:10.1093/med/9780199331215.003.0066

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Therapeutic Hypothermia in Brain Injury; doi:10.5772/3380

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, Aurelio Rodriguez, Peter Safar
Published: 1 December 1999
Surgical Clinics of North America, Volume 79, pp 1269-1289; doi:10.1016/s0039-6109(05)70077-3

The publisher has not yet granted permission to display this abstract.
Published: 1 August 2008
Journal of Emergency Nursing, Volume 34, pp 320-323; doi:10.1016/j.jen.2007.06.026

T. Pellis, V. Mione, W. P. Mercante
Anaesthesia, Pharmacology, Intensive Care and Emergency Medicine A.P.I.C.E. pp 119-127; doi:10.1007/978-88-470-2014-6_11

Joseph P Ornato, Carmelo Graffagnino, , , Eyal Herzog
Therapeutic Hypothermia and Temperature Management, Volume 2, pp 109-111; doi:10.1089/ther.2012.1513

, , Stephen Duffy, James Shaw, David Kaye
International Journal of Clinical Reviews; doi:10.5275/ijcr.2012.01.04

Therapeutic Hypothermia After Cardiac Arrest pp 61-68; doi:10.1007/978-1-4471-2951-6_6

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Ruth SoRelle
Emergency Medicine News, Volume 30; doi:10.1097/01.eem.0000319573.08558.ef

Martin Smith
Anaesthesia & Intensive Care Medicine, Volume 17, pp 602-606; doi:10.1016/j.mpaic.2016.09.014

Joanna E. Wright
Critical Care Nursing Quarterly, Volume 28, pp 150-161; doi:10.1097/00002727-200504000-00007

Mohammad Sarraf, Demetris Yannopoulos
International Journal of Clinical Reviews; doi:10.5275/ijcr.2011.10.06

Farid Sadaka
Therapeutic Hypothermia in Brain Injury; doi:10.5772/49049

Abstract:
Prehospital Therapeutic Hypothermia for Cardiac Arrest | InTechOpen, Published on: 2013-01-30. Authors: Farid Sadaka
W Dalton Dietrich, Participants Michel Le May, Justin B Lundbye, Mark Preston Adams
Therapeutic Hypothermia and Temperature Management, Volume 3, pp 161-165; doi:10.1089/ther.2013.1515

Current Neurology and Neuroscience Reports, Volume 6, pp 509-517; doi:10.1007/s11910-006-0054-3

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