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Induced Hypothermia for Neuroprotection: Understanding the Underlying Mechanisms

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Abstract

In the past few years, the use of therapeutic hypothermia as a tool to mitigate neurological injury has gained a firm foothold in many intensive care units (ICU) throughout Europe and, to a lesser degree, in the United States. Currently, in the adult setting its most widespread use is in patients who remain comatose after cardiac arrest. Several studies using historical controls, followed by two randomized controlled trials, have demonstrated that use of induced hypothermia following cardiac arrest improves neurological outcome in patients with witnessed arrests and an initial rhythm of ventricular fibrillation (VF) or ventricular tachycardia (VT) [1,2]. These benefits were observed in spite of the fact that the speed of induction of hypothermia (cooling rates) was relatively slow, especially in the larger of the two studies; target temperatures were achieved only after an average period of 8 hours in the multicentered Hypothermia after Cardiac Arrest (HACA) trial [1]. In the second study, where cooling was initiated very early (in the ambulance during the patients’ transport to the hospital, by administering refrigerated fluids), cooling rates were much faster, although it still took about 2 1/2 hours to reach target temperature [2]. Regarding the observed benefits, the HACA trial reported an absolute increase in rates of favorable neurological outcome of 16% (relative increase 41%); an absolute increase of 23% (relative increase 88%) was reported in the second study. A meta-analysis by Holzer et al. [3] concluded that the number needed to treat to achieve one additional patient with a good neurological outcome was 6, a number that compares very favorably to many other interventions both inside and outside of the ICU setting.

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  1. Department of Intensive Care Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands

    K. H. Polderman

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  1. Department of Intensive Care Erasme Hospital, Free University of Brussels, Route de Lennik 808, 1070, Brussels, Belgium

    Jean-Louis Vincent MD, PhD, FCCM, FCCP (Head) (Head)

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Polderman, K.H. (2006). Induced Hypothermia for Neuroprotection: Understanding the Underlying Mechanisms. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/0-387-35096-9_31

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