Beyond Indication and Contraindication

  • Nariyuki Hayashi
  • Dalton W. Dietrich


At the emergency medical center, management of severe brain damage caused by trauma, stroke, brain hypoxia, or cardiac arrest requires an assessment of the condition reversibility in addition to indications for treatment [1,2]. The reversibility of severe brain injury is decided not only by the severity of brain damage, age, time after insult, and original cause of brain damage, but also the level of medical management. For the success of brain hypothermia treatment beyond contraindication, advanced brain hypothermia intensive care unit (ICU) management techniques must be applied early on. Factors that decide the prognosis of severely braininjured patients include the Glasgow Coma Scale (GCS), complicated trauma of major organs, age, sex, start of treatment time, type of original disease, immune activity, and cardiopulmonary function. To introduce the new concept of treatment beyond indication and contraindication, the treatment goal must be determined for each severely brain-injured patient. For instance, injury with a GCS of 3 is very difficult to recover from without neurological deficit or persistent vegetation [1].


Cardiac Arrest Glasgow Coma Scale Brain Damage Severe Brain Injury Brain Hypoxia 
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  1. 1.
    Hayashi N (2000) The clinical issue and effectiveness of brain hypothermia treatment for severe brain injured patients. In: Hayashi N (ed) Brain hypothermia. Springer, Berlin Heidelberg New York Tokyo, pp 121–151CrossRefGoogle Scholar
  2. 2.
    Nagao K, Hayashi N, Kanmatsuse K, Arima K, Ohtsuki J, Kikushima K, Watanabe I (2000) Cardiopulmonary cerebral resuscitation using emergency cardiopulmonary bypass, coronary reperfusion therapy and mild hypothermia in patients with cardiac arrest outside the hospital. J Am Coll Cardiol 36:776–783PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2004

Authors and Affiliations

  • Nariyuki Hayashi
    • 1
    • 2
  • Dalton W. Dietrich
    • 3
    • 4
  1. 1.Nihon University Emergency Medical CenterTokyoJapan
  2. 2.Department of Emergency and Critical Care MedicineNihon University School of MedicineTokyoJapan
  3. 3.Department of Neurological Surgery, Neurology and Cell Biology and AnatomyUniversity of Miami School of MedicineMiamiUSA
  4. 4.The Miami Project to Cure ParalysisMiamiUSA

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