Therapeutic Hypothermia for Neurological Injuries: Balancing Neuroprotection with Risks

While the therapeutic potential of hypothermia for treating tissue damage has been investigated for over 90 years, its effectiveness is still debated. This review introduces the history of hypothermia in medicine first, followed by a description of cellular mechanisms behind its neuroprotective effects observed in animal studies and some clinical studies. The next section focuses on current cooling approaches/devices, as well as cooling parameters recommended by researchers and clinicians to maximize the benefits of hypothermia. Animal and clinical studies of implementing hypothermia for spinal cord and brain tissue injury are presented next. The outcomes in treating conditions like traumatic brain injury (TBI), spinal cord injury (SCI), stroke, and cardiopulmonary issues will be discussed in detail. The review also examines the risks and benefits of hypothermia, supported or disputed by clinical studies. Contributions from bioengineers in the research field are presented in the last section, with details of cooling device design and theoretical simulations. Ultimately, the review highlights that successful hypothermia treatment hinges on achieving targeted tissue cooling quickly after injury, with mild hypothermia often being proven as effective as deeper cooling, provided a slow rewarming rate is implemented.