Therapeutic Hypothermia in Trauma Management: New Tricks for an Old Dog?

Abstract

Neurologic injury is the most common cause of death in patients with out-of-hospital cardiac arrest (OHCA). Targeted temperature management or therapeutic hypothermia (TH) is commonly recommended for survivors of cardiac arrest as a common final pathway of various mechanisms to alleviate the neurologic injury. Induced hypothermia can be separated into three phases: induction, maintenance and rewarming; and each phase produces several changes in normal physiology. The induction of mild to moderate TH to a target temperature 32 ºC to 34 ºC in the initial hours after cardiac arrest improves the neurologic outcome of resuscitated patients. However, recent studies failed to provide convincing data for the beneficial effects of TH in practice. The main focus for early management of severe traumatic brain injury (TBI) is to eliminate the hazards of secondary injury, especially hypotension and hypoxia, which are known to herald worse outcomes. The administration of mild TH has also been shown to improve neurological outcomes in severe TBI. Although, the exact mechanisms are still elusive, it is known that hypothermia exerts its effects in many pathways of injury in TBI. The utility of TH, in addition to treatment for cardiac arrest, is noted in the course of acute brain injuries. It should be noted that the evidence is not yet sufficient to recommend routine use of TH for TBI outside of research settings.