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Hypothermia and injury.

Samuel A Tisherman1

  • 1Department of Surgery, Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. tishermansa@ccm.upmc.edu

Current Opinion in Critical Care
|December 24, 2004
PubMed
Summary

Mild therapeutic hypothermia shows promise in laboratory studies for trauma and hemorrhagic shock. However, clinical data remains mixed, necessitating further research into controlled hypothermia and suspended animation for severe trauma.

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Area of Science:

  • Trauma and Emergency Medicine
  • Physiology
  • Critical Care

Background:

  • Mild therapeutic hypothermia (MTH) has shown promise in improving outcomes for various injuries.
  • Previous clinical studies indicated hypothermia might be detrimental to trauma patients, possibly due to differences between uncontrolled and controlled hypothermia.
  • Interest is growing in hypothermia's potential benefits post-injury, necessitating a review of existing data.

Purpose of the Study:

  • To review laboratory and clinical data on hypothermia in traumatic hemorrhagic shock.
  • To discuss suspended animation as a novel approach for exsanguinating trauma.
  • To explore the role of therapeutic hypothermia in traumatic brain injury.

Main Methods:

  • Review of laboratory studies on hemorrhagic shock and hypothermia.
  • Analysis of clinical data associating hypothermia with trauma outcomes.
  • Examination of research on suspended animation for exsanguination.
  • Discussion of therapeutic hypothermia trials for traumatic brain injury.

Main Results:

  • Laboratory studies in large animal models demonstrate improved survival with mild hypothermia in hemorrhagic shock with trauma.
  • Clinical studies continue to show an association between hypothermia and worse outcomes in trauma patients.
  • Laboratory studies show the feasibility of suspended animation for exsanguination cardiac arrest.
  • Recent clinical trials for traumatic brain injury did not show overall benefit, but mild hypothermia on arrival correlated with better outcomes if maintained.

Conclusions:

  • A dichotomy exists between beneficial laboratory findings and detrimental clinical observations of hypothermia in trauma.
  • Preventing hypothermia in trauma patients is currently considered prudent.
  • Suspended animation shows promise for exsanguinating trauma patients.
  • Clinical trials investigating mild hypothermia during hemorrhagic shock and suspended animation are indicated.

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