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Sample records for prehospital therapeutic hypothermia

  1. Therapeutic Hypothermia for Neuroprotection

    PubMed Central

    Karnatovskaia, Lioudmila V.; Wartenberg, Katja E.

    2014-01-01

    The earliest recorded application of therapeutic hypothermia in medicine spans about 5000 years; however, its use has become widespread since 2002, following the demonstration of both safety and efficacy of regimens requiring only a mild (32°C-35°C) degree of cooling after cardiac arrest. We review the mechanisms by which hypothermia confers neuroprotection as well as its physiological effects by body system and its associated risks. With regard to clinical applications, we present evidence on the role of hypothermia in traumatic brain injury, intracranial pressure elevation, stroke, subarachnoid hemorrhage, spinal cord injury, hepatic encephalopathy, and neonatal peripartum encephalopathy. Based on the current knowledge and areas undergoing or in need of further exploration, we feel that therapeutic hypothermia holds promise in the treatment of patients with various forms of neurologic injury; however, additional quality studies are needed before its true role is fully known. PMID:24982721

  2. Imaging of prehospital stroke therapeutics

    PubMed Central

    Lin, Michelle P; Sanossian, Nerses; Liebeskind, David S

    2016-01-01

    Despite significant quality improvement efforts to streamline in-hospital acute stroke care in the conventional model, there remain inherent layers of treatment delays, which could be eliminated with prehospital diagnostics and therapeutics administered in a mobile stroke unit. Early diagnosis using Telestroke and neuroimaging while in the ambulance may enable targeted routing to hospitals with specialized care, which will likely improve patient outcomes. Key clinical trials in Telestroke, mobile stroke units with prehospital neuroimaging capability, prehospital ultrasound and co-administration of various classes of neuroprotectives, antiplatelets and antithrombin agents with intravenous thrombolysis are discussed in this article. PMID:26308602

  3. Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest.

    PubMed

    Hammer, Laure; Vitrat, François; Savary, Dominique; Debaty, Guillaume; Santre, Charles; Durand, Michel; Dessertaine, Geraldine; Timsit, Jean-François

    2009-06-01

    Therapeutic hypothermia (TH) improves the outcomes of cardiac arrest (CA) survivors. The aim of this study was to evaluate retrospectively the efficacy and safety of an immediate prehospital cooling procedure implemented just after the return of spontaneous circulation with a prehospital setting. During 30 months, the case records of comatose survivors of out-of-hospital CA presumably due to a cardiac disease were studied. A routine protocol of immediate postresuscitation cooling had been tested by an emergency team, which consisted of an infusion of large-volume, ice-cold intravenous saline. We decided to assess the efficacy and tolerance of this procedure. A total of 99 patients were studied; 22 were treated with prehospital TH, and 77 consecutive patients treated with prehospital standard resuscitation served as controls. For all patients, TH was maintained for 12 to 24 hours. The demographic, clinical, and biological characteristics of the patients were similar in the 2 groups. The rate of patients with a body temperature of less than 35 degrees C upon admission was 41% in the cooling group and 18% in the control group. Rapid infusion of fluid was not associated with pulmonary edema. After 1 year of follow-up, 6 (27%) of 22 patients in the cooling group and 30 (39%) of 77 patients in the control group had a good outcome. Our preliminary observation suggests that in comatose survivors of CA, prehospital TH with infusion of large-volume, ice-cold intravenous saline is feasible and can be used safely by mobile emergency and intensive care units. PMID:19497463

  4. Therapeutic hypothermia for stroke: Where to go?

    PubMed

    Han, Ziping; Liu, Xiangrong; Luo, Yumin; Ji, Xunming

    2015-10-01

    Ischemic stroke is a major cause of death and long-term disability worldwide. Thrombolysis with recombinant tissue plasminogen activator is the only proven and effective treatment for acute ischemic stroke; however, therapeutic hypothermia is increasingly recognized as having a tissue-protective function and positively influencing neurological outcome, especially in cases of ischemia caused by cardiac arrest or hypoxic-ischemic encephalopathy in newborns. Yet, many aspects of hypothermia as a treatment for ischemic stroke remain unknown. Large-scale studies examining the effects of hypothermia on stroke are currently underway. This review discusses the mechanisms underlying the effect of hypothermia, as well as trends in hypothermia induction methods, methods for achieving optimal protection, side effects, and therapeutic strategies combining hypothermia with other neuroprotective treatments. Finally, outstanding issues that must be addressed before hypothermia treatment is implemented at a clinical level are also presented. PMID:26057949

  5. Stridor in asphyxiated neonates undergoing therapeutic hypothermia.

    PubMed

    Orme, Judith; Kissack, Christopher; Becher, Julie-Clare

    2014-07-01

    Therapeutic hypothermia is an established standard of care in the treatment of hypoxic-ischemic encephalopathy. Application of therapeutic hypothermia in the clinical setting may reveal a wider spectrum of adverse events than previously reported. We report 5 cases of transient respiratory stridor in 51 infants, occurring at different time points in the cooling process, which appeared to be unrelated to the intubation procedure. Therapeutic hypothermia was associated with transient stridor in this case series. Formal laryngoscopy is required to determine the underlying pathologic etiology.

  6. [Implementation of therapeutic hypothermia into clinical practice].

    PubMed

    Himmel, Friederike; Desch, Steffen; Wolfrum, Sebastian

    2015-08-01

    Implementation of mild therapeutic hypothermia after cardiac arrest into clinical practice is a continuing process. Although ILCOR recommendation was given in 2003, only 24% of the German hospitals reported the use of hypothermia in this setting in 2005. Growing evidence and most importantly the implementation of hypothermia into the guidelines led to a significant increase of acceptance of this therapeutic option leading to a user rate of 69% in 2009. Encouraged by the new guidelines from 2010 86% of German hospitals finally reported to use hypothermia after cardiac arrest routinely in 2012, a decade after publication of the mile stone studies. The phenomenon of a delayed implementation of hypothermia into clinical practice can be seen throughout the world as many surveys from different countries at different time points have shown. When hypothermia is used, hospitals go with the guidelines quite strictly with respect to indication, duration of treatment and target temperature. This strengthens the importance of guidelines in the process to implement new therapeutic options. However, although a recent study still promotes a strict target temperature management it questions the need for a markedly reduced target temperature of 33°C. It remains to be elucidated how this study will affect the daily routine in the hospitals and most interestingly how this study will change the coming guidelines in 2015. PMID:26261928

  7. State of the Art in Therapeutic Hypothermia

    PubMed Central

    Lampe, Joshua W.; Becker, Lance B.

    2012-01-01

    Historically, hypothermia was induced prior to surgery to enable procedures with prolonged ischemia, such as open heart surgery and organ transplant. Within the past decade, the efficacy of hypothermia to treat emergency cases of ongoing ischemia such as stroke, myocardial infarction, and cardiac arrest has been studied. Although the exact role of ischemia/reperfusion is unclear clinically, hypothermia holds significant promise for improving outcomes for patients suffering from reperfusion after ischemia. Research has elucidated two distinct windows of opportunity for clinical use of hypothermia. In the early intra-ischemia window, hypothermia modulates abnormal cellular free radical production, poor calcium management, and poor pH management. In the more delayed post-reperfusion window, hypothermia modulates the downstream necrotic, apoptotic, and inflammatory pathways that cause delayed cell death. Improved cooling and monitoring technologies are required to realize the full potential of this therapy. Herein we discuss the current state of clinical practice, clinical trials, recommendations for cooling, and ongoing research on therapeutic hypothermia. PMID:20854174

  8. Therapeutic hypothermia for acute brain injuries.

    PubMed

    Andresen, Max; Gazmuri, Jose Tomás; Marín, Arnaldo; Regueira, Tomas; Rovegno, Maximiliano

    2015-01-01

    Therapeutic hypothermia, recently termed target temperature management (TTM), is the cornerstone of neuroprotective strategy. Dating to the pioneer works of Fay, nearly 75 years of basic and clinical evidence support its therapeutic value. Although hypothermia decreases the metabolic rate to restore the supply and demand of O₂, it has other tissue-specific effects, such as decreasing excitotoxicity, limiting inflammation, preventing ATP depletion, reducing free radical production and also intracellular calcium overload to avoid apoptosis. Currently, mild hypothermia (33°C) has become a standard in post-resuscitative care and perinatal asphyxia. However, evidence indicates that hypothermia could be useful in neurologic injuries, such as stroke, subarachnoid hemorrhage and traumatic brain injury. In this review, we discuss the basic and clinical evidence supporting the use of TTM in critical care for acute brain injury that extends beyond care after cardiac arrest, such as for ischemic and hemorrhagic strokes, subarachnoid hemorrhage, and traumatic brain injury. We review the historical perspectives of TTM, provide an overview of the techniques and protocols and the pathophysiologic consequences of hypothermia. In addition, we include our experience of managing patients with acute brain injuries treated using endovascular hypothermia. PMID:26043908

  9. Therapeutic hypothermia for acute brain injuries.

    PubMed

    Andresen, Max; Gazmuri, Jose Tomás; Marín, Arnaldo; Regueira, Tomas; Rovegno, Maximiliano

    2015-06-05

    Therapeutic hypothermia, recently termed target temperature management (TTM), is the cornerstone of neuroprotective strategy. Dating to the pioneer works of Fay, nearly 75 years of basic and clinical evidence support its therapeutic value. Although hypothermia decreases the metabolic rate to restore the supply and demand of O₂, it has other tissue-specific effects, such as decreasing excitotoxicity, limiting inflammation, preventing ATP depletion, reducing free radical production and also intracellular calcium overload to avoid apoptosis. Currently, mild hypothermia (33°C) has become a standard in post-resuscitative care and perinatal asphyxia. However, evidence indicates that hypothermia could be useful in neurologic injuries, such as stroke, subarachnoid hemorrhage and traumatic brain injury. In this review, we discuss the basic and clinical evidence supporting the use of TTM in critical care for acute brain injury that extends beyond care after cardiac arrest, such as for ischemic and hemorrhagic strokes, subarachnoid hemorrhage, and traumatic brain injury. We review the historical perspectives of TTM, provide an overview of the techniques and protocols and the pathophysiologic consequences of hypothermia. In addition, we include our experience of managing patients with acute brain injuries treated using endovascular hypothermia.

  10. Equipment to prevent, diagnose, and treat hypothermia: a survey of Norwegian pre-hospital services

    PubMed Central

    2013-01-01

    Introduction Hypothermia is associated with increased morbidity and mortality in trauma patients and poses a challenge in pre-hospital treatment. The aim of this study was to identify equipment to prevent, diagnose, and treat hypothermia in Norwegian pre-hospital services. Method In the period of April-August 2011, we conducted a survey of 42 respondents representing a total of 543 pre-hospital units, which included all the national ground ambulance services, the fixed wing and helicopter air ambulance service, and the national search and rescue service. The survey explored available insulation materials, active warming devices, and the presence of protocols describing wrapping methods, temperature monitoring, and the use of warm i.v. fluids. Results Throughout the services, hospital duvets, cotton blankets and plastic “bubble-wrap” were the most common insulation materials. Active warming devices were to a small degree available in vehicle ambulances (14%) and the fixed wing ambulance service (44%) but were more common in the helicopter services (58-70%). Suitable thermometers for diagnosing hypothermia were lacking in the vehicle ambulance services (12%). Protocols describing how to insulate patients were present for 73% of vehicle ambulances and 70% of Search and Rescue helicopters. The minority of Helicopter Emergency Medical Services (42%) and Fixed Wing (22%) units was reported to have such protocols. Conclusion The most common equipment types to treat and prevent hypothermia in Norwegian pre-hospital services are duvets, plastic “bubble wrap”, and cotton blankets. Active external heating devices and suitable thermometers are not available in most vehicle ambulance units. PMID:23938145

  11. Effects of prehospital hypothermia on transfusion requirements and outcomes: a retrospective observatory trial

    PubMed Central

    Klauke, Nora; Gräff, Ingo; Fleischer, Andreas; Boehm, Olaf; Guttenthaler, Vera; Baumgarten, Georg; Meybohm, Patrick; Wittmann, Maria

    2016-01-01

    Objectives Prehospital hypothermia is defined as a core temperature <36.0°C and has been shown to be an independent risk factor for early death in patients with trauma. In a retrospective study, a possible correlation between the body temperature at the time of admission to the emergency room and subsequent in-hospital transfusion requirements and the in-hospital mortality rate was explored. Setting This is a retrospective single-centre study at a primary care hospital in Germany. Participants 15 895 patients were included in this study. Patients were classified by admission temperature and transfusion rate. Excluded were ambulant patients and patients with missing data. Primary and secondary outcome measures The primary outcome values were length of stay (LOS) in days, in-hospital mortality, the transferred amount of packed red blood cells (PRBCs), and admission to an intensive care unit. Secondary influencing variables were the patient's age and the Glasgow Coma Scale. Results In 22.85% of the patients, hypothermia was documented. Hypothermic patients died earlier in the course of their hospital stay than non-hypothermic patients (p<0.001). The administration of 1–3 PRBC increased the LOS significantly (p<0.001) and transfused patients had an increased risk of death (p<0.001). Prehospital hypothermia could be an independent risk factor for mortality (adjusted OR 8.521; p=0.001) and increases the relative risk for transfusion by factor 2.0 (OR 2.007; p=0.002). Conclusions Low body temperature at hospital admission is associated with a higher risk of transfusion and death. Hence, a greater awareness of prehospital temperature management should be established. PMID:27029772

  12. [Recent treatment of postischaemic anoxic brain damage after cardiac arrest by using therapeutic hypothermia].

    PubMed

    Andjelić, Sladjana

    2008-01-01

    Organ injury caused by ischaemia and anoxia during prolonged cardiac arrest is compounded by reperfusion injury that occurs when spontaneous circulation is restored. Mild hypothermia (32-35 degrees C) is neuroprotective through several mechanisms, including suppression of apoptosis, reduced production of excitotoxins and free radicals, and anti-inflammatory actions. Experimental studies show that hypothermia is more effective the earlier it is started after return of spontaneous circulation (ROSC). Two randomised clinical trials show improved survival and neurological outcome in adults who remained comatose after initial resuscitation from prehospital VF cardiac arrest, and who were cooled after ROSC. Different strategies can be used to induce hypothermia. Optimal timing of therapeutic hypothermia for cardiac ischaemia is unknown. In patients who failed to respond to standard cardiopulmonary resuscitation, intra-arrest cooling using ice-cold intravenous (i.v.) fluid improved the chance of survival. Recently, fasudil, a Rho kinase inhibitor, was reported to prevent cerebral ischaemia in vivo by increasing cerebral blood flow and inhibiting inflammatory responses. In future, two different kinds of protective therapies, BCL-2 overexpression and hypothermia,will both inhibit aspects of apoptotic cell death cascades, and that combination treatment can prolong the temporal "therapeutic window" for gene therapy. PMID:19069351

  13. The therapeutic potential of regulated hypothermia.

    PubMed

    Gordon, C J

    2001-03-01

    Reducing body temperature of rodents has been found to improve their survival to ischaemia, hypoxia, chemical toxicants, and many other types of insults. Larger species, including humans, may also benefit from a lower body temperature when recovering from CNS ischaemia and other traumatic insults. Rodents subjected to these insults undergo a regulated hypothermic response (that is, decrease in set point temperature) characterised by preference for cooler ambient temperatures, peripheral vasodilatation, and reduced metabolic rate. However, forced hypothermia (that is, body temperature forced below set point) is the only method used in the study and treatment of human pathological insults. The therapeutic efficacy of the hypothermic treatment is likely to be influenced by the nature of the reduction in body temperature (that is, forced versus regulated). Homeostatic mechanisms counter forced reductions in body temperature resulting in physiological stress and decreased efficacy of the hypothermic treatment. On the other hand, regulated hypothermia would seem to be the best means of achieving a therapeutic benefit because thermal homeostatic systems mediate a controlled reduction in core temperature. PMID:11300205

  14. The therapeutic potential of regulated hypothermia

    PubMed Central

    Gordon, C.

    2001-01-01

    Reducing body temperature of rodents has been found to improve their survival to ischaemia, hypoxia, chemical toxicants, and many other types of insults. Larger species, including humans, may also benefit from a lower body temperature when recovering from CNS ischaemia and other traumatic insults. Rodents subjected to these insults undergo a regulated hypothermic response (that is, decrease in set point temperature) characterised by preference for cooler ambient temperatures, peripheral vasodilatation, and reduced metabolic rate. However, forced hypothermia (that is, body temperature forced below set point) is the only method used in the study and treatment of human pathological insults. The therapeutic efficacy of the hypothermic treatment is likely to be influenced by the nature of the reduction in body temperature (that is, forced versus regulated). Homeostatic mechanisms counter forced reductions in body temperature resulting in physiological stress and decreased efficacy of the hypothermic treatment. On the other hand, regulated hypothermia would seem to be the best means of achieving a therapeutic benefit because thermal homeostatic systems mediate a controlled reduction in core temperature. PMID:11300205

  15. Therapeutic hypothermia after cardiac arrest: outcome predictors

    PubMed Central

    Leão, Rodrigo Nazário; Ávila, Paulo; Cavaco, Raquel; Germano, Nuno; Bento, Luís

    2015-01-01

    Objective The determination of coma patient prognosis after cardiac arrest has clinical, ethical and social implications. Neurological examination, imaging and biochemical markers are helpful tools accepted as reliable in predicting recovery. With the advent of therapeutic hypothermia, these data need to be reconfirmed. In this study, we attempted to determine the validity of different markers, which can be used in the detection of patients with poor prognosis under hypothermia. Methods Data from adult patients admitted to our intensive care unit for a hypothermia protocol after cardiac arrest were recorded prospectively to generate a descriptive and analytical study analyzing the relationship between clinical, neurophysiological, imaging and biochemical parameters with 6-month outcomes defined according to the Cerebral Performance Categories scale (good 1-2, poor 3-5). Neuron-specific enolase was collected at 72 hours. Imaging and neurophysiologic exams were carried out in the 24 hours after the rewarming period. Results Sixty-seven patients were included in the study, of which 12 had good neurological outcomes. Ventricular fibrillation and electroencephalographic theta activity were associated with increased likelihood of survival and improved neurological outcomes. Patients who had more rapid cooling (mean time of 163 versus 312 minutes), hypoxic-ischemic brain injury on magnetic resonance imaging or neuron-specific enolase > 58ng/mL had poor neurological outcomes (p < 0.05). Conclusion Hypoxic-ischemic brain injury on magnetic resonance imaging and neuron-specific enolase were strong predictors of poor neurological outcomes. Although there is the belief that early achievement of target temperature improves neurological prognoses, in our study, there were increased mortality and worse neurological outcomes with earlier target-temperature achievement. PMID:26761469

  16. Comparison of three different prehospital wrapping methods for preventing hypothermia - a crossover study in humans

    PubMed Central

    2011-01-01

    Background Accidental hypothermia increases mortality and morbidity in trauma patients. Various methods for insulating and wrapping hypothermic patients are used worldwide. The aim of this study was to compare the thermal insulating effects and comfort of bubble wrap, ambulance blankets / quilts, and Hibler's method, a low-cost method combining a plastic outer layer with an insulating layer. Methods Eight volunteers were dressed in moistened clothing, exposed to a cold and windy environment then wrapped using one of the three different insulation methods in random order on three different days. They were rested quietly on their back for 60 minutes in a cold climatic chamber. Skin temperature, rectal temperature, oxygen consumption were measured, and metabolic heat production was calculated. A questionnaire was used for a subjective evaluation of comfort, thermal sensation, and shivering. Results Skin temperature was significantly higher 15 minutes after wrapping using Hibler's method compared with wrapping with ambulance blankets / quilts or bubble wrap. There were no differences in core temperature between the three insulating methods. The subjects reported more shivering, they felt colder, were more uncomfortable, and had an increased heat production when using bubble wrap compared with the other two methods. Hibler's method was the volunteers preferred method for preventing hypothermia. Bubble wrap was the least effective insulating method, and seemed to require significantly higher heat production to compensate for increased heat loss. Conclusions This study demonstrated that a combination of vapour tight layer and an additional dry insulating layer (Hibler's method) is the most efficient wrapping method to prevent heat loss, as shown by increased skin temperatures, lower metabolic rate and better thermal comfort. This should then be the method of choice when wrapping a wet patient at risk of developing hypothermia in prehospital environments. PMID:21699720

  17. Inducing Therapeutic Hypothermia in Cardiac Arrest Caused by Lightning Strike.

    PubMed

    Scantling, Dane; Frank, Brian; Pontell, Mathew E; Medinilla, Sandra

    2016-09-01

    Only limited clinical scenarios are grounds for induction of therapeutic hypothermia. Its use in traumatic cardiac arrests, including those from lightning strikes, is not well studied. Nonshockable cardiac arrest rhythms have only recently been included in resuscitation guidelines. We report a case of full neurological recovery with therapeutic hypothermia after a lightning-induced pulseless electrical activity cardiac arrest in an 18-year-old woman. We also review the important pathophysiology of lightning-induced cardiac arrest and neurologic sequelae, elaborate upon the mechanism of therapeutic hypothermia, and add case-based evidence in favor of the use of targeted temperature management in lightning-induced cardiac arrest. PMID:27451005

  18. Inducing Therapeutic Hypothermia in Cardiac Arrest Caused by Lightning Strike.

    PubMed

    Scantling, Dane; Frank, Brian; Pontell, Mathew E; Medinilla, Sandra

    2016-09-01

    Only limited clinical scenarios are grounds for induction of therapeutic hypothermia. Its use in traumatic cardiac arrests, including those from lightning strikes, is not well studied. Nonshockable cardiac arrest rhythms have only recently been included in resuscitation guidelines. We report a case of full neurological recovery with therapeutic hypothermia after a lightning-induced pulseless electrical activity cardiac arrest in an 18-year-old woman. We also review the important pathophysiology of lightning-induced cardiac arrest and neurologic sequelae, elaborate upon the mechanism of therapeutic hypothermia, and add case-based evidence in favor of the use of targeted temperature management in lightning-induced cardiac arrest.

  19. Effects of therapeutic hypothermia on the glial proteome and phenotype.

    PubMed

    Kim, Jong-Heon; Seo, Minchul; Suk, Kyoungho

    2013-02-01

    Therapeutic hypothermia is a useful intervention against brain injury in experimental models and patients, but its therapeutic applications are limited due to its ill-defined mode of action. Glia cells maintain homeostasis and protect the central nervous system from environmental change, but after brain injury, glia are activated and induce glial scar formation and secondary injury. On the other hand, therapeutic hypothermia has been shown to modulate glial hyperactivation under various brain injury conditions. We considered that knowledge of the effect of hypothermia on the molecular profiles of glia and on their phenotypes would improve our understanding of the neuroprotective mechanism of hypothermia. Here, we review the findings of recent studies that examined the effect of hypothermia on proteome changes in reactive glial cells in vitro and in vivo. The therapeutic effects of hypothermia are associated with the inhibition of reactive oxygen species generation, the maintenance of ion homeostasis, and the protection of neurovascular units in cultured glial cells. In an animal model, a distinct pattern of protein alterations was detected in glia following hypothermia under ischemic/reperfusion conditions. In particular, hypothermia was found to exert a neuroprotective effect against ischemic brain injury by regulating specific glial signaling pathways, such as, glutamate signaling, cell death, and stress response, and by influencing neural dysfunction, neurogenesis, neural plasticity, cell differentiation, and neurotrophic activity. Furthermore, the proteins that were differentially expressed belonged to various pathways and could mediate diverse phenotypic changes of glia in vitro or in vivo. Therefore, hypothermia-modulated glial proteins and subsequent phenotypic changes may form the basis of the therapeutic effects of hypothermia. PMID:23441897

  20. Therapeutic hypothermia and ischemic stroke: A literature review

    PubMed Central

    Tahir, Rizwan A.; Pabaney, Aqueel H.

    2016-01-01

    Background: Ischemic stroke is the fifth leading cause of death in the US. Clinical techniques aimed at helping to reduce the morbidity associated with stroke have been studied extensively, including therapeutic hypothermia. In this study, the authors review the literature regarding the role of therapeutic hypothermia in ischemic stroke to appreciate the evolution of hypothermia technology over several decades and to critically analyze several early clinical studies to validate its use in ischemic stroke. Methods: A comprehensive literature search was performed using PubMed and Google Scholar databases. Search terms included “hypothermia and ischemic stroke” and “therapeutic hypothermia.” A comprehensive search of the current clinical trials using clinicaltrials.gov was conducted using the keywords “stroke and hypothermia” to evaluate early and ongoing clinical trials utilizing hypothermia in ischemic stroke. Results: A comprehensive review of the evolution of hypothermia in stroke and the current status of this treatment was performed. Clinical studies were critically analyzed to appreciate their strengths and pitfalls. Ongoing and future registered clinical studies were highlighted and analyzed compared to the reported results of previous trials. Conclusion: Although hypothermia has been used for various purposes over several decades, its efficacy in the treatment of ischemic stroke is debatable. Several trials have proven its safety and feasibility; however, more robust, randomized clinical trials with large volumes of patients are needed to fully establish its utility in the clinical setting. PMID:27313963

  1. Neonatal Encephalopathy: Update on Therapeutic Hypothermia and Other Novel Therapeutics.

    PubMed

    McAdams, Ryan M; Juul, Sandra E

    2016-09-01

    Neonatal encephalopathy (NE) is a major cause of neonatal mortality and morbidity. Therapeutic hypothermia (TH) is standard treatment for newborns at 36 weeks of gestation or greater with intrapartum hypoxia-related NE. Term and late preterm infants with moderate to severe encephalopathy show improved survival and neurodevelopmental outcomes at 18 months of age after TH. TH can increase survival without increasing major disability, rates of an IQ less than 70, or cerebral palsy. Neonates with severe NE remain at risk of death or severe neurodevelopmental impairment. This review discusses the evidence supporting TH for term or near term neonates with NE. PMID:27524449

  2. [Hypothermia].

    PubMed

    García Iriarte, Antxon; Sáenz Mendía, Raquel; Marín Fernández, Blanca

    2010-01-01

    A deep understanding about the causes and situations which predispose a patient to hypothermia can prevent its progression and the emergence of complications which present life-threatening risks and can lead to irreversible organ deterioration. The distinct degrees of hypothermia require a diagnosis and a distinct therapeutic treatment which share common pillars based on: the need to employ general measures which counterarrest the deterioration of those organs caused by heat loss; and the use of internal or external reheating methods which vary due to the degree of hypothermia and the hemodynamic stability of the patient. In moderate or severe cases, a nurse's role, as one who collaborates in patient treatment, requires paying special attention to strict monitoring of vital constants, neurological, metabolic and cardio-respiratory signs, as well as collaborating in various therapeutic procedures. As a nursing diagnosis, hypothermia refers to those situations in which a nurse's professional competence capacitates he/she to carry out actions which resolve that prejudicial situation a patient faces.

  3. [Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy].

    PubMed

    Gulczyńska, Ewa; Gadzinowski, Janusz

    2012-03-01

    Hypoxia-ischemia in the perinatal period is a serious condition affecting infants, which can result in death and cerebral palsy and associated disabilities. There has been significant research progress in hypoxic-ischemic encephalopathy over the last 2 decades. Many new molecular mechanisms of asphyxia have been identified. Despite all these advances, therapeutic interventions in HIE remain to be limited. Recently it has been revealed that mild therapeutic hypothermia is the only modality shown to improve neurologic outcome. The authors present a summary of pathogenesis of HIE, animal studies of cooling for hypoxic and ischemic models, and first publications on human therapeutic hypothermia trials. The diagnosis of encephalopathy in full-term neonates and enrollment criteria for hypothermia are also discussed. The current data from randomized control trials of hypothermia as neuroprotection for full and near-term infants are presented along with the results of meta-analyses of these trials. Finally the status of ongoing neonatal hypothermia trials as well as status of therapeutic hypothermia in Poland is summarized.

  4. Therapeutic Hypothermia and the Risk of Hemorrhage

    PubMed Central

    Wang, Chih-Hung; Chen, Nai-Chuan; Tsai, Min-Shan; Yu, Ping-Hsun; Wang, An-Yi; Chang, Wei-Tien; Huang, Chien-Hua; Chen, Wen-Jone

    2015-01-01

    Abstract Current guidelines recommend a period of moderate therapeutic hypothermia (TH) for comatose patients after cardiac arrest to improve clinical outcomes. However, in-vitro studies have reported platelet dysfunction, thrombocytopenia, and coagulopathy, results that might discourage clinicians from applying TH in clinical practice. We aimed to quantify the risks of hemorrhage observed in clinical studies. Medline and Embase were searched from inception to October 2015. Randomized controlled trials (RCTs) comparing patients undergoing TH with controls were selected, irrespective of the indications for TH. There were no restrictions for language, population, or publication year. Data on study characteristics, which included patients, details of intervention, and outcome measures, were extracted. Forty-three trials that included 7528 patients were identified from 2692 potentially relevant references. Any hemorrhage was designated as the primary outcome and was reported in 28 studies. The pooled results showed no significant increase in hemorrhage risk associated with TH (risk difference [RD] 0.005; 95% confidence interval [CI] −0.001–0.011; I2, 0%). Among secondary outcomes, patients undergoing TH were found to have increased risk of thrombocytopenia (RD 0.109; 95% CI 0.038–0.179; I2 57.3%) and transfusion requirements (RD 0.021; 95% CI 0.003–0.040; I2 0%). The meta-regression analysis indicated that prolonged duration of cooling may be associated with increased risk of hemorrhage. TH was not associated with increased risk of hemorrhage despite the increased risk of thrombocytopenia and transfusion requirements. Clinicians should cautiously assess each patient's risk-benefit profile before applying TH. PMID:26632746

  5. Successful Use of Therapeutic Hypothermia in a Pregnant Patient

    PubMed Central

    Oyetayo, Ola O.; Stewart, David; Costa, Steven M.; Jones, Richard O.

    2015-01-01

    Out-of-hospital cardiac arrest is a leading cause of death in the United States. Pregnant women are not immune to cardiac arrest, and the treatment of such patients can be difficult. Pregnancy is a relative contraindication to the use of therapeutic hypothermia after cardiac arrest. A 20-year-old woman who was 18 weeks pregnant had an out-of-hospital cardiac arrest. Upon her arrival at the emergency department, she was resuscitated and her circulation returned spontaneously, but her score on the Glasgow Coma Scale was 3. After adequate family discussion of the risks and benefits of therapeutic hypothermia, a decision was made to initiate therapeutic hypothermia per established protocol for 24 hours. The patient was successfully cooled and rewarmed. By the time she was discharged, she had experienced complete neurologic recovery, apart from some short-term memory loss. Subsequently, at 40 weeks, she delivered vaginally a 7-lb 3-oz girl whose Apgar scores were 8 and 9, at 1 and 5 minutes respectively. To our knowledge, this is only the 3rd reported case of a successful outcome following the initiation of therapeutic hypothermia for out-of-hospital cardiac arrest in a pregnant woman. On the basis of this and previous reports of successful outcomes, we recommend that therapeutic hypothermia be considered an option in the management of out-of-hospital cardiac arrest in the pregnant population. To facilitate a successful outcome, a multidisciplinary approach involving cardiology, emergency medicine, obstetrics, and neurology should be used. PMID:26413021

  6. [Prolonged therapeutic hypothermia after pericardial effusion drain surgery].

    PubMed

    Román Fernández, A; López Álvarez, A; Barreiro Canosa, J L; Varela García, O; Fossati Puertas, S; Pereira Tamayo, J Á

    2014-01-01

    Therapeutic hypothermia is an effective treatment for neurological protection after out-of-hospital cardiac arrest, and may also be beneficial for in-hospital cardiac arrest. Its use is limited in post-surgical patients due to the risk of specific complications, particularly bleeding. There are significant differences among previous publications regarding the time to reach the target temperature and the duration of therapy, so the optimal strategy is not yet established. We present the case of a patient who suffered a perioperative cardiac arrest related to a pericardial tamponade, and who underwent therapeutic hypothermia for 48h.

  7. History and current use of mild therapeutic hypothermia after cardiac arrest

    PubMed Central

    Alan, David; Vejvoda, Jiri; Honek, Jakub; Veselka, Josef

    2016-01-01

    In spite of many years of development and implementation of pre-hospital advanced life support programmes, the survival rate of out-of-hospital cardiac arrest (OHCA) used to be very poor. Neurologic injury from cerebral hypoxia is the most common cause of death in patients with OHCA. In the past two decades, post-resuscitation care has developed many new concepts aimed at improving the neurological outcome and survival rate of patients after cardiac arrest. Systematic post-cardiac arrest care after the return of spontaneous circulation, including induced mild therapeutic hypothermia (TH) in selected patients, is aimed at significantly improving rates of long-term neurologically intact survival. This review summarises the history and current knowledge in the field of mild TH after OHCA. PMID:27695505

  8. Isolation Syndrome after Cardiac Arrest and Therapeutic Hypothermia

    PubMed Central

    Forgacs, Peter B.; Fridman, Esteban A.; Goldfine, Andrew M.; Schiff, Nicholas D.

    2016-01-01

    Here, we present the first description of an isolation syndrome in a patient who suffered prolonged cardiac arrest and underwent a standard therapeutic hypothermia protocol. Two years after the arrest, the patient demonstrated no motor responses to commands, communication capabilities, or visual tracking at the bedside. However, resting neuronal metabolism and electrical activity across the entire anterior forebrain was found to be normal despite severe structural injuries to primary motor, parietal, and occipital cortices. In addition, using quantitative electroencephalography, the patient showed evidence for willful modulation of brain activity in response to auditory commands revealing covert conscious awareness. A possible explanation for this striking dissociation in this patient is that altered neuronal recovery patterns following therapeutic hypothermia may lead to a disproportionate preservation of anterior forebrain cortico-thalamic circuits even in the setting of severe hypoxic injury to other brain areas. Compared to recent reports of other severely brain-injured subjects with such dissociation of clinically observable (overt) and covert behaviors, we propose that this case represents a potentially generalizable mechanism producing an isolation syndrome of blindness, motor paralysis, and retained cognition as a sequela of cardiac arrest and therapeutic hypothermia. Our findings further support that highly-preserved anterior cortico-thalamic integrity is associated with the presence of conscious awareness independent from the degree of injury to other brain areas. PMID:27375420

  9. Isolation Syndrome after Cardiac Arrest and Therapeutic Hypothermia.

    PubMed

    Forgacs, Peter B; Fridman, Esteban A; Goldfine, Andrew M; Schiff, Nicholas D

    2016-01-01

    Here, we present the first description of an isolation syndrome in a patient who suffered prolonged cardiac arrest and underwent a standard therapeutic hypothermia protocol. Two years after the arrest, the patient demonstrated no motor responses to commands, communication capabilities, or visual tracking at the bedside. However, resting neuronal metabolism and electrical activity across the entire anterior forebrain was found to be normal despite severe structural injuries to primary motor, parietal, and occipital cortices. In addition, using quantitative electroencephalography, the patient showed evidence for willful modulation of brain activity in response to auditory commands revealing covert conscious awareness. A possible explanation for this striking dissociation in this patient is that altered neuronal recovery patterns following therapeutic hypothermia may lead to a disproportionate preservation of anterior forebrain cortico-thalamic circuits even in the setting of severe hypoxic injury to other brain areas. Compared to recent reports of other severely brain-injured subjects with such dissociation of clinically observable (overt) and covert behaviors, we propose that this case represents a potentially generalizable mechanism producing an isolation syndrome of blindness, motor paralysis, and retained cognition as a sequela of cardiac arrest and therapeutic hypothermia. Our findings further support that highly-preserved anterior cortico-thalamic integrity is associated with the presence of conscious awareness independent from the degree of injury to other brain areas. PMID:27375420

  10. Therapeutic Hypothermia in Stroke and Traumatic Brain Injury

    PubMed Central

    Faridar, Alireza; Bershad, Eric M.; Emiru, Tenbit; Iaizzo, Paul A.; Suarez, Jose I.; Divani, Afshin A.

    2011-01-01

    Therapeutic hypothermia (TH) is considered to improve survival with favorable neurological outcome in the case of global cerebral ischemia after cardiac arrest and perinatal asphyxia. The efficacy of hypothermia in acute ischemic stroke (AIS) and traumatic brain injury (TBI), however, is not well studied. Induction of TH typically requires a multimodal approach, including the use of both pharmacological agents and physical techniques. To date, clinical outcomes for patients with either AIS or TBI who received TH have yielded conflicting results; thus, no adequate therapeutic consensus has been reached. Nevertheless, it seems that by determining optimal TH parameters and also appropriate applications, cooling therapy still has the potential to become a valuable neuroprotective intervention. Among the various methods for hypothermia induction, intravascular cooling (IVC) may have the most promise in the awake patient in terms of clinical outcomes. Currently, the IVC method has the capability of more rapid target temperature attainment and more precise control of temperature. However, this technique requires expertise in endovascular surgery that can preclude its application in the field and/or in most emergency settings. It is very likely that combining neuroprotective strategies will yield better outcomes than utilizing a single approach. PMID:22207862

  11. Therapeutic hypothermia impacts leukocyte kinetics after cardiac arrest

    PubMed Central

    Dufner, Matthias C.; Andre, Florian; Stiepak, Jan; Zelniker, Thomas; Chorianopoulos, Emmanuel; Preusch, Michael; Katus, Hugo A.

    2016-01-01

    Background Patients admitted to the hospital after primarily successful cardiopulmonary resuscitation (CPR) are at a very high risk for neurologic deficits and death. Targeted temperature management (TTM) for mild therapeutic hypothermia has been shown to improve survival compared to standard treatment. Acute cardiovascular events, such as myocardial infarction (MI), are a major cause for cardiac arrest (CA) in patients who undergo CPR. Recent findings have demonstrated the importance and impact of the leukocyte response following acute MI. Methods In this retrospective, single center study we enrolled 169 patients with CA due to non-traumatic causes and primarily successful CPR. A total of 111 subjects (66%) underwent TTM aiming for a target temperature of 32–34 °C. Results Analysis of 30 day follow up showed a significantly improved survival of all patients who received TTM compared to patients without hypothermia (P=0.0001). Furthermore TTM was an independent variable of good neurological outcome after 6 months (P=0.0030). Therapeutic hypothermia was found to be beneficial independent of differences in age and sex between both groups. While a higher rate of pneumonia was observed with TTM, this diagnosis had no additional impact on survival or neurological outcome. The beneficial effect on mortality remained significant in patients with the diagnosis of an acute cardiac event (P=0.0145). Next, we evaluated the kinetics of leukocytes in this group over the course of 7 days after CA. At presentation, patients showed a mean level of 16.5±6.7 of leukocytes per microliter. While this level stayed stable in the group of patients without hypothermia, patients who received TTM showed a significant decline of leukocyte levels resulting in significantly lower numbers of leukocytes on days 3 and 5 after CPR. Interestingly, these differences in leukocyte counts remained beyond the time period of TTM while C-reactive protein (CRP) levels were suppressed only during

  12. Hypothermia.

    PubMed

    Turk, Elisabeth E

    2010-06-01

    Hypothermia refers to a situation where there is a drop in body core temperature below 35 degrees C. It is a potentially fatal condition. In forensic medicine and pathology, cases of hypothermia often pose a special challenge to experts because of their complex nature, and the often absent or nonspecific nature of morphological findings. The scene of the incident may raise suspicions of a crime initially, due to phenomena such as terminal burrowing behavior and paradoxical undressing. An element of hypothermia often contributes to the cause of death in drug- and alcohol-related fatalities, in the homeless, in immersion deaths, in accidents and in cases of abuse or neglect, making the condition extremely relevant to forensic medical specialists. The aim of this review is to give an overview of the pathophysiological aspects of hypothermia and to illustrate different aspects relevant to forensic medical casework. PMID:20151230

  13. Hypothermia

    MedlinePlus

    Cold weather can affect your body in different ways. You can get frostbite, which is an injury to the ... Anyone who spends much time outdoors in cold weather can get hypothermia. You can also get it ...

  14. Translating drug-induced hibernation to therapeutic hypothermia.

    PubMed

    Jinka, Tulasi R; Combs, Velva M; Drew, Kelly L

    2015-06-17

    Therapeutic hypothermia (TH) improves prognosis after cardiac arrest; however, thermoregulatory responses such as shivering complicate cooling. Hibernators exhibit a profound and safe reversible hypothermia without any cardiovascular side effects by lowering the shivering threshold at low ambient temperatures (Ta). Activation of adenosine A1 receptors (A1ARs) in the central nervous system (CNS) induces hibernation in hibernating species and a hibernation-like state in rats, principally by attenuating thermogenesis. Thus, we tested the hypothesis that targeted activation of the central A1AR combined with a lower Ta would provide a means of managing core body temperature (Tb) below 37 °C for therapeutic purposes. We targeted the A1AR within the CNS by combining systemic delivery of the A1AR agonist (6)N-cyclohexyladenosine (CHA) with 8-(p-sulfophenyl)theophylline (8-SPT), a nonspecific adenosine receptor antagonist that does not readily cross the blood-brain barrier. Results show that CHA (1 mg/kg) and 8-SPT (25 mg/kg), administered intraperitoneally every 4 h for 20 h at a Ta of 16 °C, induce and maintain the Tb between 29 and 31 °C for 24 h in both naïve rats and rats subjected to asphyxial cardiac arrest for 8 min. Faster and more stable hypothermia was achieved by continuous infusion of CHA delivered subcutaneously via minipumps. Animals subjected to cardiac arrest and cooled by CHA survived better and showed less neuronal cell death than normothermic control animals. Central A1AR activation in combination with a thermal gradient shows promise as a novel and effective pharmacological adjunct for inducing safe and reversible targeted temperature management.

  15. Rapid rewarming after therapeutic hypothermia worsens outcome in sepsis

    PubMed Central

    Jo, You Hwan; Kim, Kyuseok; Lee, Jae Hyuk; Rim, Kwang Pil; Cho, In Soo

    2014-01-01

    Objective This study was performed to investigate the effect of the rewarming rate on survival and acute lung injury in sepsis. Methods Male Sprague-Dawley rats underwent cecal ligation and incision. After 1 hour of sepsis induction, normothermia (37°C±0.5°C, NT group) or hypothermia (32°C±0.5°C) was induced. Hypothermia was maintained for 4 hours and rats were divided into two groups according to the rewarming rate: RW1 group, 1 hour of rewarming; and RW2 group, 2 hours of rewarming. In the survival study, rats were observed for 12 hours after sepsis induction (n=6 per group). In the second experiment, rats were sacrificed 7 hours after sepsis induction, and lung tissues and plasma were harvested (n=10 per group). Results In the survival study, the RW2 group survived longer than the RW1 group (P<0.05), but the RW1 and NT groups showed no significant difference in survival duration (P>0.05). The histological lung injury score and malondialdehyde concentrations in the lung tissues were significantly higher in the RW1 group than in the RW2 group (P<0.05). Plasma interleukin (IL)-6 concentration and the ratio of IL-6 to IL-10 were higher in the RW1 group than in the RW2 group (P<0.05). Conclusion Rapid rewarming after therapeutic hypothermia results in a shorter survival period and acute lung injury in sepsis, which could be associated with the inflammatory responses.

  16. Lower Incidence of Seizure among Neonates Treated with Therapeutic Hypothermia

    PubMed Central

    Orbach, Sharon A; Bonifacio, Sonia L; Kuzniewicz, Michael; Glass, Hannah C

    2013-01-01

    Animal studies suggest that hypothermia decreases seizure burden, while limited human data are inconclusive. This retrospective cohort study examines the relationship between therapeutic hypothermia and seizure in neonates with hypoxic-ischemic encephalopathy. Our center admitted 224 neonates from July 2004 to December 2011 who met institutional cooling criteria. Seventy-three neonates were born during the pre-cooling era, prior to November 2007, and 151 were born during the cooling era. Among neonates with moderate encephalopathy, the incidence of seizure in cooled infants was less than half the incidence in those not cooled (26% cooling versus 61% pre-cooling era; RR=0.43, 95% CI 0.30 to 0.61). Among neonates with severe encephalopathy, there was no difference in the incidence (83% versus 87%; RR=1.05, 95% CI 0.78 to 1.39). These results support animal data and suggest a mechanism by which neonates with moderate encephalopathy may benefit more from cooling than neonates with severe encephalopathy. PMID:24334344

  17. Ultrasonography of the internal carotid artery during therapeutic hypothermia.

    PubMed

    Fukuda, Sumio; Tanimura, Tomoshige; Iwaki, Toshihiko; Higuchi, Machiko; Suyama, Megumi; Goto, Tomoki; Koide, Wakato; Maki, Kanemasa; Ushijima, Katsumi; Ban, Kyoko

    2016-07-01

    The purpose of this study was to determine the accuracy of mean blood flow velocity (mean V) in the internal carotid artery (ICA) for prediction of outcome in infants with hypoxic-ischemic encephalopathy (HIE) exposed to therapeutic hypothermia (TH). Five newborns with HIE who met the criteria for TH were enrolled. Ultrasonography of the right and left ICA was performed before, during, and after TH. Mean V of the sampling point in each ICA was measured. Mean V was suppressed during TH and increased after rewarming in four infants with normal neurological development. In one infant with neurological disability, however, mean V increased during TH and decreased after therapy. In conclusion, cervical ultrasonography for ICA in infants during TH may be useful for the prediction of neurodevelopmental outcome. PMID:27460402

  18. Neurodevelopmental Follow Up After Therapeutic Hypothermia for Perinatal Asphyxia

    PubMed Central

    Zubcevic, Smail; Heljic, Suada; Catibusic, Feriha; Uzicanin, Sajra; Sadikovic, Mirna; Krdzalic, Belma

    2015-01-01

    Introduction: Neuroprotective benefit of therapeutic hypothermia in term newborns with hypoxic-ischemic encephalopathy (HIE) was assessed by analyzing survival and neurodevelopmental outcome of neonates subjected to this procedure. Material and methods: Newborns with gestational age > 36 weeks and < 6 hours of age with moderate to severe asphyxial encephalopathy underwent cooling protocol at a temperature of 33.5 °C for 72 hours and rewarming period of 6 hours. Outcome measures assessed were death and neurodevelopmental characteristics, which were compared at the different age using ASQ-3. Twenty-five children were assessed at age 3-6, 12-18 and 24-36 months. Median gestational age was 40 weeks, birth weight 3470 g, Apgar score 2/4 and pH on admission to the hospital 7.02. Four (16%) children died. Results: At the first assessment developmental categories of communication were normal in 78.9%, problem solving in 63.2%, personal-social in 68.4%, gross motor in 68.4%, and fine motor in 42.1% with a high need of retesting in this area. Second assessment was done in 17 patients: developmental categories of communication normal in 58.8%, problem solving in 70.6%, personal-social in 64.7%, gross motor in 64.7%, and fine motor in 35.3%. Third evaluation was done in 14 patients: developmental categories of communication were normal in 64.3%, problem solving in 71.4%, personal-social in 57.1%, gross motor in 64.3%, and fine motor in 42.9%. Conclusion: There was no correlation between baseline parameters and outcome. Results of the study are showing that therapeutic hypothermia in term newborns can provide better survival and less neurologic sequels in HIE patients. PMID:26843725

  19. The use of therapeutic hypothermia in the management of amniotic fluid embolism

    PubMed Central

    Barriuso, Valeria; Pombar, Xavier; Bankowski, Heather A

    2013-01-01

    Background: Amniotic fluid embolism (AFE) is a rare peripartum obstetric emergency where patients seldom survive neurologically intact. The exact pathophysiology is not completely understood and treatment remains mainly supportive. Case: A 34-year-old African American woman gravida 1, para 0-0-0-0 at 38 weeks and four days induced for chronic hypertension with superimposed preeclampsia experienced an AFE during labour. Supportive treatment included early use of therapeutic hypothermia resulting in a normal neurological outcome. Conclusion: This case demonstrates the timely use of therapeutic hypothermia in a patient surviving an AFE and suffering no neurological sequelae. Therapeutic hypothermia should be considered in the supportive treatment of AFE.

  20. Maintenance of whole-body therapeutic hypothermia during patient transport and magnetic resonance imaging.

    PubMed

    Wu, Tai-Wei; McLean, Claire; Friedlich, Philippe; Grimm, John; Bluml, Stefan; Seri, Istvan

    2014-05-01

    Therapeutic hypothermia has become standard treatment for neonatal hypoxic-ischemic encephalopathy (HIE), with brain MRI commonly performed after the child has been rewarmed. However, early imaging during hypothermia might provide information important in designing clinical trials that refine and personalize therapeutic hypothermia. We tested a protocol to ensure safety and maintenance of hypothermia during in-hospital transport and MRI. MRI during therapeutic hypothermia was performed in 13 newborns on the 2nd-3rd postnatal days. Mean one-way transport time was 20.0 ± 3.3 min. Mean rectal temperatures (°C) leaving the unit, upon arrival at the MR suite, during MRI scan and upon return to the unit were 33.5 ± 0.3 °C, 33.3 ± 0.3 °C, 33.1 ± 0.4 °C and 33.4 ± 0.3 °C, respectively. Using our protocol therapeutic hypothermia was safely and effectively continued during in-hospital transport and MRI without adverse effects.

  1. Outcome After Therapeutic Hypothermia in Term Neonates With Encephalopathy and a Syndromic Diagnosis.

    PubMed

    Mrelashvili, Anna; Bonifacio, Sonia L; Rogers, Elizabeth E; Shimotake, Thomas K; Glass, Hannah C

    2015-10-01

    The large randomized, controlled trials of therapeutic hypothermia for hypoxic-ischemic encephalopathy excluded neonates with congenital disorders. The objective of this study was to report our experience using hypothermia in neonates with signs of hypoxic-ischemic encephalopathy and a syndromic disorder or brain anomaly. Subjects were identified from a database of neonates admitted to the Neuro-Intensive Care Nursery at University of California, San Francisco. Of 169 patients fulfilling criteria for hypothermia, 8 (5%) had a syndromic disorder and were cooled per guidelines for nonsyndromic neonates. Perinatal characteristics of infants with and without syndromic disorder were not significantly different. Overall outcome was poor: 38% had evidence of acute hypoxic-ischemic injury, 3 subjects died, and 2 survivors had low developmental quotient (ie, 25). The risk versus benefit of therapeutic hypothermia for hypoxic-ischemic encephalopathy among neonates with congenital brain malformations or syndromic diagnoses is uncertain.

  2. Outcome After Therapeutic Hypothermia in Term Neonates With Encephalopathy and a Syndromic Diagnosis.

    PubMed

    Mrelashvili, Anna; Bonifacio, Sonia L; Rogers, Elizabeth E; Shimotake, Thomas K; Glass, Hannah C

    2015-10-01

    The large randomized, controlled trials of therapeutic hypothermia for hypoxic-ischemic encephalopathy excluded neonates with congenital disorders. The objective of this study was to report our experience using hypothermia in neonates with signs of hypoxic-ischemic encephalopathy and a syndromic disorder or brain anomaly. Subjects were identified from a database of neonates admitted to the Neuro-Intensive Care Nursery at University of California, San Francisco. Of 169 patients fulfilling criteria for hypothermia, 8 (5%) had a syndromic disorder and were cooled per guidelines for nonsyndromic neonates. Perinatal characteristics of infants with and without syndromic disorder were not significantly different. Overall outcome was poor: 38% had evidence of acute hypoxic-ischemic injury, 3 subjects died, and 2 survivors had low developmental quotient (ie, 25). The risk versus benefit of therapeutic hypothermia for hypoxic-ischemic encephalopathy among neonates with congenital brain malformations or syndromic diagnoses is uncertain. PMID:25762585

  3. Outcome After Therapeutic Hypothermia in Term Neonates with Encephalopathy and a Syndromic Diagnosis

    PubMed Central

    Mrelashvili, Anna; Bonifacio, Sonia L.; Rogers, Elizabeth E.; Shimotake, Thomas K.; Glass, Hannah C.

    2015-01-01

    The large randomized, controlled trials of therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE) excluded neonates with congenital disorders. The objective of this study was to report our experience using hypothermia in neonates with signs of HIE and a syndromic disorder or brain anomaly. Subjects were identified from a database of neonates admitted to the Neuro-Intensive Care Nursery at University of California, San Francisco. Of 169 patients fulfilling criteria for hypothermia, eight (5%) had a syndromic disorder, and were cooled as per guidelines for non-syndromic neonates. Perinatal characteristics of infants with and without syndromic disorder were not significantly different. Overall outcome was poor: 38% had evidence of acute HI injury, 3 subjects died, two survivors had low developmental quotient (DQ 25). The risk versus benefit of therapeutic hypothermia for HIE among neonates with congenital brain malformations or syndromic diagnoses is uncertain. PMID:25762585

  4. Urine Output Changes During Postcardiac Arrest Therapeutic Hypothermia.

    PubMed

    Raper, Jaron D; Wang, Henry E

    2013-12-01

    While commonly described, no studies have characterized cold-induced diuresis or rewarm anti-diuresis occurring during the delivery of therapeutic hypothermia (TH). We sought to determine urine output changes during the provision of postcardiac arrest TH. We analyzed clinical data on patients receiving postcardiac arrest TH at an urban tertiary care center. TH measures included cooling by cold intravenous fluid, external ice packs, and a commercial external temperature management system. TH treatment was divided into phases: (1) induction, (2) maintenance, (3) rewarm, and (4) post-rewarm. The primary outcome measure was the mean urine output rate (mL/hour). We compared urine output rates between TH phases using a Generalized Estimating Equations model, defining urine output rate (mL/hour) as the dependent variable and TH phase (induction, maintenance, rewarm, and post-rewarm) as the primary exposure variable. We adjusted for age, sex, initial ECG rhythm, location of arrest, shock, acute kidney injury, rate of intravenous fluid input, and body mass index. Complete urine output data were available on 33 patients. Mean urine output rates during induction, maintenance, rewarm, and post-rewarm phases were 157 mL/hour (95% CI: 104-210), 103 mL/hour (95% CI: 82-125), 70 mL/hour (95% CI: 51-88), and 91 mL/hour (95% CI: 65-117), respectively. Compared with the post-rewarm phase, adjusted urine output was higher during the TH induction phase (output rate difference +51 mL/hour; 95% CI: 3-99). Adjusted urine output during the maintenance and rewarm phases did not differ from the post-rewarm phase. In this preliminary study, we observed modest increases in urine output during TH induction. We did not observe urine output changes during TH maintenance or rewarming. PMID:24380030

  5. Delayed and Prolonged Local Brain Hypothermia Combined with Decompressive Craniectomy: A Novel Therapeutic Strategy That Modulates Glial Dynamics

    PubMed Central

    Kim, Jong-Heon; Yun, Sung-Ho; Jang, Kwang-Ho; Park, Jaechan; Han, Hyung Soo; Rhee, Dongick

    2014-01-01

    Hypothermia is considered a useful intervention for limiting pathophysiological changes after brain injury. Local hypothermia is a relatively safe and convenient intervention that circumvents many of the complications associated with systemic hypothermia. However, successful hypothermia treatment requires careful consideration of several factors including its practicality, feasibility, and associated risks. Here, we review the protective effects-and the cellular mechanisms that underlie them-of delayed and prolonged local hypothermia in rodent and canine brain injury models. The data show that the protective effects of therapeutic hypothermia, which mainly result from the modulation of inflammatory glial dynamics, are limited. We argue that decompressive craniectomy can be used to overcome the limitations of local brain hypothermia without causing histological abnormalities or other detrimental effects to the cooled area. Therefore, delayed and prolonged local brain hypothermia at the site of craniectomy is a promising intervention that may prove effective in the clinical setting. PMID:24963275

  6. Feasibility and Safety of Therapeutic Hypothermia and Short Term Outcome in Neonates with Hypoxic Ischemic Encephalopathy.

    PubMed

    Purkayastha, Jayashree; Lewis, Leslie Edward; Bhat, Ramesh Y; Anusha, K M

    2016-02-01

    Therapeutic hypothermia is well known for neuroprotection in asphyxiated neonates with hypoxic ischemic encephalopathy. The authors aimed to study the feasibility and safety of therapeutic hypothermia and short term outcome in neonates with hypoxic ischemic encephalopathy (HIE). Total 31 neonates with moderate to severe HIE were enrolled in the study. Continuous temperature recording was noted in 31 neonates; 17 neonates were studied prospectively while 14 neonates were studied retrospectively. Rectal temperature was monitored in 31 neonates and maintained between 33 and 34 °C by switching off the warmer and using ice packs. Reusable ice packs were used which were inexpensive. Therapeutic hypothermia was maintained for 72 h and babies were then rewarmed 0.5 °C every hour. Therapeutic hypothermia was feasible and inexpensive. There was no major complication during the study. MRI was done in 17 neonates; 52 % were found to have normal MRI at the end of first week. Among the study neonates (n = 31) 64.5 % were neurologically normal at the time of discharge. To conclude, therapeutic hypothermia is feasible in a low resource setting and is a safe way of neuroprotection. Short term outcome was also favourable in these neonates. PMID:26141549

  7. Therapeutic Hypothermia in Spinal Cord Injury: The Status of Its Use and Open Questions.

    PubMed

    Wang, Jiaqiong; Pearse, Damien D

    2015-01-01

    Spinal cord injury (SCI) is a major health problem and is associated with a diversity of neurological symptoms. Pathophysiologically, dysfunction after SCI results from the culmination of tissue damage produced both by the primary insult and a range of secondary injury mechanisms. The application of hypothermia has been demonstrated to be neuroprotective after SCI in both experimental and human studies. The myriad of protective mechanisms of hypothermia include the slowing down of metabolism, decreasing free radical generation, inhibiting excitotoxicity and apoptosis, ameliorating inflammation, preserving the blood spinal cord barrier, inhibiting astrogliosis, promoting angiogenesis, as well as decreasing axonal damage and encouraging neurogenesis. Hypothermia has also been combined with other interventions, such as antioxidants, anesthetics, alkalinization and cell transplantation for additional benefit. Although a large body of work has reported on the effectiveness of hypothermia as a neuroprotective approach after SCI and its application has been translated to the clinic, a number of questions still remain regarding its use, including the identification of hypothermia's therapeutic window, optimal duration and the most appropriate rewarming rate. In addition, it is necessary to investigate the neuroprotective effect of combining therapeutic hypothermia with other treatment strategies for putative synergies, particularly those involving neurorepair. PMID:26213924

  8. Therapeutic Hypothermia Protocol in a Community Emergency Department

    PubMed Central

    Kulstad, Christine E.; Holt, Shannon C.; Abrahamsen, Aaron A.; Lovell, Elise O.

    2010-01-01

    Objectives: Therapeutic hypothermia (TH) has been shown to improve survival and neurological outcome in patients resuscitated after out of hospital cardiac arrest (OHCA) from ventricular fibrillation/ventricular tachycardia (VF/VT). We evaluated the effects of using a TH protocol in a large community hospital emergency department (ED) for all patients with neurological impairment after resuscitated OHCA regardless of presenting rhythm. We hypothesized improved mortality and neurological outcomes without increased complication rates. Methods: Our TH protocol entails cooling to 33°C for 24 hours with an endovascular catheter. We studied patients treated with this protocol from November 2006 to November 2008. All non-pregnant, unresponsive adult patients resuscitated from any initial rhythm were included. Exclusion criteria were initial hypotension or temperature less than 30°C, trauma, primary intracranial event, and coagulopathy. Control patients treated during the 12 months before the institution of our TH protocol met the same inclusion and exclusion criteria. We recorded survival to hospital discharge, neurological status at discharge, and rates of bleeding, sepsis, pneumonia, renal failure, and dysrhythmias in the first 72 hours of treatment. Results: Mortality rates were 71.1% (95% CI, 56–86%) for 38 patients treated with TH and 72.3% (95% CI 59–86%) for 47 controls. In the TH group, 8% of patients (95% CI, 0–17%) had a good neurological outcome on discharge, compared to 0 (95% CI 0–8%) in the control group. In 17 patients with VF/VT treated with TH, mortality was 47% (95% CI 21–74%) and 18% (95% CI 0–38%) had good neurological outcome; in 9 control patients with VF/VT, mortality was 67% (95% CI 28–100%), and 0% (95% CI 0–30%) had good neurological outcome. The groups were well-matched with respect to sex and age. Complication rates were similar or favored the TH group. Conclusion: Instituting a TH protocol for OHCA patients with any

  9. Temperature Control During Therapeutic Hypothermia for Newborn Encephalopathy Using Different Blanketrol Devices

    PubMed Central

    Kilbride, Howard; Shepherd, Edward; McDonald, Scott A.; Shankaran, Seetha; Truog, William; Das, Abhik; Higgins, Rosemary D.

    2014-01-01

    Therapeutic hypothermia improves the survival and neurodevelopmental outcome of infants with newborn encephalopathy of a hypoxic-ischemic origin. The NICHD Neonatal Research Network (NRN) Whole Body Cooling trial used the Cincinnati Sub-Zero Blanketrol II to achieve therapeutic hypothermia. The Blanketrol III is now available and provides additional cooling modes that may result in better temperature control. This report is a retrospective comparison of infants undergoing hypothermia using two different cooling modes of the Blanketrol device. Infants from the NRN trial were cooled with the Blanketrol II using the Automatic control mode (B2 cohort) and were compared with infants from two new NRN centers that adopted the NRN protocol and used the Blanketrol III in a gradient mode (B3 cohort). The primary outcome was the percent time the esophageal temperature stayed between 33°C and 34°C (target 33.5°C) during maintenance of hypothermia. Cohorts had similar birth weight, gestational age, and level of encephalopathy at the initiation of therapy. Baseline esophageal temperature differed between groups (36.6°C±1.0°C for B2 vs. 33.9°C±1.2°C for B3, p<0.0001) reflecting the practice of passive cooling during transport prior to initiation of active device cooling in the B3 cohort. This difference prevented comparison of temperatures during induction of hypothermia. During maintenance of hypothermia the mean and standard deviation of the percent time between 33°C and 34°C was similar for B2 compared to B3 cohorts (94.8%±0.1% vs. 95.8%±0.1%, respectively). Both the automatic and gradient control modes of the Blanketrol devices appear comparable in maintaining esophageal temperature within the target range during maintenance of therapeutic hypothermia. PMID:25285767

  10. Improved Therapeutic Benefits by Combining Physical Cooling With Pharmacological Hypothermia After Severe Stroke in Rats

    PubMed Central

    Lee, Jin Hwan; Wei, Ling; Gu, Xiaohuan; Won, Soonmi; Wei, Zheng Zachory; Dix, Thomas A.

    2016-01-01

    Background and Purpose— Therapeutic hypothermia is a promising strategy for treatment of acute stroke. Clinical translation of therapeutic hypothermia, however, has been hindered because of the lack of efficiency and adverse effects. We sought to enhance the clinical potential of therapeutic hypothermia by combining physical cooling (PC) with pharmacologically induced hypothermia after ischemic stroke. Methods— Wistar rats were subjected to 90-minute middle cerebral artery occlusion by insertion of an intraluminal filament. Mild-to-moderate hypothermia was induced 120 minutes after the onset of stroke by PC alone, a neurotensin receptor 1 (NTR1) agonist HPI-201 (formally ABS-201) alone or the combination of both. The outcomes of stroke were evaluated at 3 and 21 days after stroke. Results— PC or HPI-201 each showed hypothermic effect and neuroprotection in stroke rats. The combination of PC and HPI-201 exhibited synergistic effects in cooling process, reduced infarct formation, cell death, and blood-brain barrier damages and improved functional recovery after stroke. Importantly, coapplied HPI-201 completely inhibited PC-associated shivering and tachycardia. Conclusions— The centrally acting hypothermic drug HPI-201 greatly enhanced the efficiency and efficacy of conventional PC; this combined cooling therapy may facilitate clinical translation of hypothermic treatment for stroke. PMID:27301934

  11. [The role of therapeutic hypothermia in post-resuscitation care - review of the literature and personal experience].

    PubMed

    Pilecky, Dávid; Szudi, Gábor; Kovács, Enikő; Jenei, Zsigmond; Gellér, László; Heltai, Krisztina; Molnár, Levente; Bárczi, György; Becker, Dávid; Merkely, Béla; Zima, Endre

    2016-04-17

    In the last fifteen years mild therapeutic hypothermia became an accepted and widespread therapeutic method in the treatment of successfully resuscitated patients due to sudden cardiac death. Based on the available evidence therapeutic hypothermia is part of the resuscitation guidelines, however, many aspects of its therapeutic use are based on empirical facts. In particular, the subjects of intense debate are the ideal target temperature and the benefit of hypothermia in patients found with non-shockable rhythm. Hypothermia affects almost all organ systems and, therefore, early detection and treatment of side effects are essential. The aim of the authors is to summarize the clinical role and pathophysiologic effects of therapeutic hypothermia in the treatment of resuscitated patients based on current evidence and their practical experience. PMID:27063428

  12. Rationale, Timeline, Study Design, and Protocol Overview of the Therapeutic Hypothermia After Pediatric Cardiac Arrest Trials

    PubMed Central

    Moler, Frank W.; Silverstein, Faye S.; Meert, Kathleen L.; Clark, Amy E.; Holubkov, Richard; Browning, Brittan; Slomine, Beth S.; Christensen, James R.; Dean, Michael

    2014-01-01

    Objective To describe the rationale, timeline, study design, and protocol overview of the Therapeutic Hypothermia after Pediatric Cardiac Arrest trials. Design Multicenter randomized controlled trials. Setting Pediatric intensive care and cardiac ICUs in the United States and Canada. Patients Children from 48 hours to 18 years old, who have return of circulation after cardiac arrest, who meet trial eligibility criteria, and whose guardians provide written consent. Interventions Therapeutic hypothermia or therapeutic normothermia. Measurements and Main Results From concept inception in 2002 until trial initiation in 2009, 7 years were required to plan and operationalize the Therapeutic Hypothermia after Pediatric Cardiac Arrest trials. Two National Institute of Child Health and Human Development clinical trial planning grants (R21 and R34) supported feasibility assessment and protocol development. Two clinical research networks, Pediatric Emergency Care Applied Research Network and Collaborative Pediatric Critical Care Research Network, provided infrastructure resources. Two National Heart Lung Blood Institute U01 awards provided funding to conduct separate trials of in-hospital and out-of-hospital cardiac arrest. A pilot vanguard phase that included half the clinical sites began on March 9, 2009, and this was followed by full trial funding through 2015. Conclusions Over a decade will have been required to plan, design, operationalize, and conduct the Therapeutic Hypothermia after Pediatric Cardiac Arrest trials. Details described in this report, such as participation of clinical research networks and clinical trial planning grants utilization, may be of utility for individuals who are planning investigator-initiated, federally supported clinical trials. PMID:23842585

  13. Therapeutic Hypothermia in Spinal Cord Injury: The Status of Its Use and Open Questions

    PubMed Central

    Wang, Jiaqiong; Pearse, Damien D.

    2015-01-01

    Spinal cord injury (SCI) is a major health problem and is associated with a diversity of neurological symptoms. Pathophysiologically, dysfunction after SCI results from the culmination of tissue damage produced both by the primary insult and a range of secondary injury mechanisms. The application of hypothermia has been demonstrated to be neuroprotective after SCI in both experimental and human studies. The myriad of protective mechanisms of hypothermia include the slowing down of metabolism, decreasing free radical generation, inhibiting excitotoxicity and apoptosis, ameliorating inflammation, preserving the blood spinal cord barrier, inhibiting astrogliosis, promoting angiogenesis, as well as decreasing axonal damage and encouraging neurogenesis. Hypothermia has also been combined with other interventions, such as antioxidants, anesthetics, alkalinization and cell transplantation for additional benefit. Although a large body of work has reported on the effectiveness of hypothermia as a neuroprotective approach after SCI and its application has been translated to the clinic, a number of questions still remain regarding its use, including the identification of hypothermia’s therapeutic window, optimal duration and the most appropriate rewarming rate. In addition, it is necessary to investigate the neuroprotective effect of combining therapeutic hypothermia with other treatment strategies for putative synergies, particularly those involving neurorepair. PMID:26213924

  14. Induction of therapeutic hypothermia via the esophagus: a proof of concept study

    PubMed Central

    Kulstad, Erik B.; Courtney, D. Mark; Waller, Donald

    2012-01-01

    BACKGROUND: Induction of hypothermia (a 4 °C decrease from baseline) improves outcomes in adult cardiac arrest and neonatal hypoxic ischemic encephalopathy, and may benefit other conditions as well. Methods used to implement or prevent hypothermia typically require skin contact with blankets or pads or intravascular access with catheter devices. The study was to evaluate the potential to induce mild therapeutic hypothermia via an esophageal route in a porcine model. METHODS: Single-animal proof-of-concept study of a prototype esophageal device in a 70 kg Yorkshire swine. We measured the rate of temperature change after placement of a prototype device to induce hypothermia via the esophagus, and compared this rate to known temperature changes that occur under similar laboratory conditions without a hypothermic device. RESULTS: Swine temperature decreased from a starting temperature of 37.8 °C to 33.8 °C (achieving the goal of a 4 °C decrease) in 175 minutes, resulting in a cooling rate of 1.37 °C/h. Histopathology of the esophagus showed normal tissue without evidence of injury. CONCLUSION: A prototype of an esophageal cooling device induced hypothermia effectively in a large single-swine model. PMID:25215049

  15. Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy - Where to from Here?

    PubMed

    Davidson, Joanne O; Wassink, Guido; van den Heuij, Lotte G; Bennet, Laura; Gunn, Alistair J

    2015-01-01

    Hypoxia-ischemia before or around the time of birth occurs in approximately 2/1000 live births and is associated with a high risk of death or lifelong disability. Therapeutic hypothermia is now well established as standard treatment for infants with moderate to severe hypoxic-ischemic encephalopathy but is only partially effective. There is compelling preclinical and clinical evidence that hypothermia is most protective when it is started as early as possible after hypoxia-ischemia. Further improvements in outcome from therapeutic hypothermia are very likely to arise from strategies to reduce the delay before starting treatment of affected infants. In this review, we examine evidence that current protocols are reasonably close to the optimal depth and duration of cooling, but that the optimal rate of rewarming after hypothermia is unclear. The potential for combination treatments to augment hypothermic neuroprotection has considerable promise, particularly with endogenous targets such as melatonin and erythropoietin, and noble gases such as xenon. We dissect the critical importance of preclinical studies using realistic delays in treatment and clinically relevant cooling protocols when examining combination treatment, and that for many strategies overlapping mechanisms of action can substantially attenuate any effects.

  16. Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy - Where to from Here?

    PubMed

    Davidson, Joanne O; Wassink, Guido; van den Heuij, Lotte G; Bennet, Laura; Gunn, Alistair J

    2015-01-01

    Hypoxia-ischemia before or around the time of birth occurs in approximately 2/1000 live births and is associated with a high risk of death or lifelong disability. Therapeutic hypothermia is now well established as standard treatment for infants with moderate to severe hypoxic-ischemic encephalopathy but is only partially effective. There is compelling preclinical and clinical evidence that hypothermia is most protective when it is started as early as possible after hypoxia-ischemia. Further improvements in outcome from therapeutic hypothermia are very likely to arise from strategies to reduce the delay before starting treatment of affected infants. In this review, we examine evidence that current protocols are reasonably close to the optimal depth and duration of cooling, but that the optimal rate of rewarming after hypothermia is unclear. The potential for combination treatments to augment hypothermic neuroprotection has considerable promise, particularly with endogenous targets such as melatonin and erythropoietin, and noble gases such as xenon. We dissect the critical importance of preclinical studies using realistic delays in treatment and clinically relevant cooling protocols when examining combination treatment, and that for many strategies overlapping mechanisms of action can substantially attenuate any effects. PMID:26441818

  17. Successful treatment of severe heatstroke with therapeutic hypothermia by a noninvasive external cooling system.

    PubMed

    Hong, Jen-Yee; Lai, Yi-Chun; Chang, Cheng-Yu; Chang, Shih-Chieh; Tang, Gau-Jun

    2012-06-01

    Heatstroke is a life-threatening disease; however, no pharmacologic treatment has proven to be effective. In severe cases with multiple organ dysfunction, the mortality remains high and many patients inevitably develop permanent neurologic damage. We report a near-fatal case of exertional heatstroke with multiple organ dysfunction, including generalized convulsions, acute lung injury, and disseminated intravascular coagulation, successfully treated with induced therapeutic hypothermia (33°C [91.4°F]) by a noninvasive external cooling system. After treatment, the patient completely recovered, without any neurologic sequelae during 1 year of follow-up. To our knowledge, this is the first reported case of using therapeutic hypothermia in heatstroke. PMID:21982153

  18. Therapeutic Hypothermia after Pediatric Cardiac Arrest Trials: The Vanguard Phase Experience and Implications for Other Trials

    PubMed Central

    Pemberton, Victoria L.; Browning, Brittan; Webster, Angie; Dean, J. Michael; Moler, Frank W.

    2012-01-01

    Objective To determine whether an 18-month vanguard phase, in the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) trials, confirmed study feasibility and patient safety, a prerequisite to continued funding by the sponsor. Design Randomized controlled trial Setting Pediatric intensive care and pediatric cardiac care units in 15 clinical sites in the United States and Canada Patients Children, aged 48 hours to 18 years of age, with return of circulation after cardiac arrest Interventions Therapeutic hypothermia versus therapeutic normothermia Measurements and Main Results The first 15 of 20 potential sites to obtain IRB and subcontract approvals were selected as vanguard sites. IRB approvals were obtained 92 days (median, interquartile range [IQR] 65–114) and subcontracts signed 34 days (IQR 20–48) after distribution. Sites screened subjects 13 days (IQR 9–21) and enrolled the first subjects 64 days (IQR 13–154) after study launch. The recruitment milestone was reached four months ahead of schedule with no safety concerns identified. Overall recruitment in this ongoing trial remains on target. Conclusions The THAPCA vanguard phase proved beneficial for the investigators and funding agency. Since complex multicenter trials are rarely ready to launch when grant funds are received, the vanguard allowed time to refine the protocol and recruitment approaches. Competition for vanguard positions led to expedient IRB and subcontract completion. Early success and sustained momentum contributed to recruitment at or above goals. Financial risks to the sponsor were minimized by tying funding for the full trial to achieving pre-specified milestones. A vanguard phase may be a desirable strategy for the successful conduct of other complex clinical trials. Clinical Trial Registration NCT00880087 and NCT00878644 http://clinicaltrials.gov/ct2/show/NCT00880087?term=pediatric+hypothermia&rank=4 http://clinicaltrials.gov/ct2/show/NCT00878644?term=pediatric+hypothermia

  19. The use of pre-hospital mild hypothermia after resuscitation from out-of-hospital cardiac arrest.

    PubMed

    Kim, Francis; Olsufka, Michele; Nichol, Graham; Copass, Michael K; Cobb, Leonard A

    2009-03-01

    Hypothermia has emerged as a potent neuroprotective modality following resuscitation from cardiac arrest. Although delayed hospital cooling has been demonstrated to improve outcome after cardiac arrest, in-field cooling begun immediately following the return of spontaneous circulation may be more beneficial. Cooling in the field following resuscitation, however, presents new challenges, in that the cooling method has to be portable, safe, and effective. Rapid infusion of intravenous fluid at 4 degrees C, the use of a cooling helmet, and cooling plates have all been proposed as methods for field cooling, and are all in various stages of clinical and animal testing. Whether field cooling will improve survival and neurologic outcome remains an important unanswered clinical question. PMID:19072587

  20. Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest in Children

    PubMed Central

    Moler, Frank W.; Silverstein, Faye S.; Holubkov, Richard; Slomine, Beth S.; Christensen, James R.; Nadkarni, Vinay M.; Meert, Kathleen L.; Clark, Amy E.; Browning, Brittan; Pemberton, Victoria L.; Page, Kent; Shankaran, Seetha; Hutchison, Jamie S.; Newth, Christopher J.L.; Bennett, Kimberly S.; Berger, John T.; Topjian, Alexis; Pineda, Jose A.; Koch, Joshua D.; Schleien, Charles L.; Dalton, Heidi J.; Ofori-Amanfo, George; Goodman, Denise M.; Fink, Ericka L.; McQuillen, Patrick; Zimmerman, Jerry J.; Thomas, Neal J.; van der Jagt, Elise W.; Porter, Melissa B.; Meyer, Michael T.; Harrison, Rick; Pham, Nga; Schwarz, Adam J.; Nowak, Jeffrey E.; Alten, Jeffrey; Wheeler, Derek S.; Bhalala, Utpal S.; Lidsky, Karen; Lloyd, Eric; Mathur, Mudit; Shah, Samir; Wu, Theodore; Theodorou, Andreas A.; Sanders, Ronald C.; Dean, J. Michael

    2015-01-01

    Background Therapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited. Methods We conducted this trial of two targeted temperature interventions at 38 children’s hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a Vineland Adaptive Behavior Scales, second edition (VABS-II), score of 70 or higher (on a scale from 20 to 160, with higher scores indicating better function), was evaluated among patients with a VABS-II score of at least 70 before cardiac arrest. Results A total of 295 patients underwent randomization. Among the 260 patients with data that could be evaluated and who had a VABS-II score of at least 70 before cardiac arrest, there was no significant difference in the primary outcome between the hypothermia group and the normothermia group (20% vs. 12%; relative likelihood, 1.54; 95% confidence interval [CI], 0.86 to 2.76; P = 0.14). Among all the patients with data that could be evaluated, the change in the VABS-II score from baseline to 12 months was not significantly different (P = 0.13) and 1-year survival was similar (38% in the hypothermia group vs. 29% in the normothermia group; relative likelihood, 1.29; 95% CI, 0.93 to 1.79; P = 0.13). The groups had similar incidences of infection and serious arrhythmias, as well as similar use of blood products and 28-day mortality. Conclusions In comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a

  1. Quantitative EEG Markers in Severe Post-resuscitation Brain Injury with Therapeutic Hypothermia

    PubMed Central

    Deng, Ruoxian; Young, Leanne M.; Jia, Xiaofeng

    2015-01-01

    Therapeutic hypothermia has been regarded as one of the most effective post-cardiac arrest (CA) treatments to improve survival and functional recovery. However, many clinical prognostic markers after resuscitation have become less reliable under hypothermia. In this study, we applied and compared two developed quantitative measures - information quantity (IQ) and sub-band IQ (SIQ) - to evaluate the accuracy of EEG markers on predicting cortical recovery under therapeutic hypothermia. A total of 14 rats under 9-min asphyxial-CA, leading to severe brain injury, were randomly divided into two groups: hypothermia (32°C-34°C) and normothermia (36.5–37.5°C) (n=7 per group). For each rat, EEG and temperature were continuously recorded for the first 15 hrs. EEG was then recorded for serial 30 mins at 24, 48 and 72 hrs. The neurologic deficit score was evaluated daily to assess the neurologic recovery. Early SIQ and IQ were both significantly correlated with the 72-hr NDS, when the rats remained comatose. Both IQ and SIQ were able to discriminate the animals with good and bad functional outcomes starting from 1 hr after resuscitation. There was no significant difference in 72-hr NDS results (hypothermia (median (25th, 75th), 65 (52, 67)) versus normothermia (53.5 (52.25, 66.75))) (p>0.05) due to the high mortality rate (5/14) with severe brain injury. Contrary to IQ recovery but similarly to NDS scores, the SIQ recovery was not significantly different between the hypothermia (0.66±0.04) and normothermia (0.64±0.04) groups (p>0.05). IQ could identify the presence of high-frequency oscillations during the recovery from severe brain injury. We demonstrated that while SIQ was able to provide additional sub-band EEG information related to the recovery of different brain functions, both early IQ and SIQ markers are able to accurately predict neurologic outcome after CA. PMID:26737805

  2. Therapeutic Hypothermia as a Neuroprotective Strategy in Neonatal Hypoxic-Ischemic Brain Injury and Traumatic Brain Injury

    PubMed Central

    Ma, H.; Sinha, B.; Pandya, R.S.; Lin, N.; Popp, A.J.; Li, J.; Yao, J.; Wang, X.

    2014-01-01

    Evidence shows that artificially lowering body and brain temperature can significantly reduce the deleterious effects of brain injury in both newborns and adults. Although the benefits of therapeutic hypothermia have long been known and applied clinically, the underlying molecular mechanisms have yet to be elucidated. Hypoxic-ischemic brain injury and traumatic brain injury both trigger a series of biochemical and molecular events that cause additional brain insult. Induction of therapeutic hypothermia seems to ameliorate the molecular cascade that culminates in neuronal damage. Hypothermia attenuates the toxicity produced by the initial injury that would normally produce reactive oxygen species, neurotransmitters, inflammatory mediators, and apoptosis. Experiments have been performed on various depths and levels of hypothermia to explore neuroprotection. This review summarizes what is currently known about the beneficial effects of therapeutic hypothermia in experimental models of neonatal hypoxic-ischemic brain injury and traumatic brain injury, and explores the molecular mechanisms that could become the targets of novel therapies. In addition, this review summarizes the clinical implications of therapeutic hypothermia in newborn hypoxic-ischemic encephalopathy and adult traumatic brain injury. PMID:22834830

  3. Optimization of induction of mild therapeutic hypothermia with cold saline infusion: A laboratory experiment.

    PubMed

    Fluher, Jure; Markota, Andrej; Stožer, Andraž; Sinkovič, Andreja

    2015-01-01

    Cold fluid infusions can be used to induce mild therapeutic hypothermia after cardiac arrest. Fluid temperature higher than 4°C can increase the volume of fluid needed, prolong the induction phase of hypothermia and thus contribute to complications. We performed a laboratory experiment with two objectives. The first objective was to analyze the effect of wrapping fluid bags in ice packs on the increase of fluid temperature with time in bags exposed to ambient conditions. The second objective was to quantify the effect of insulating venous tubing and adjusting flow rate on fluid temperature increase from bag to the level of an intravenous cannula during a simulated infusion. The temperature of fluid in bags wrapped in ice packs was significantly lower compared to controls at all time points during the 120 minutes observation. The temperature increase from the bag to the level of intravenous cannula was significantly lower for insulated tubing at all infusion rates (median temperature differences between bag and intravenous cannula were: 8.9, 4.8, 4.0, and 3.1°C, for non-insulated and 5.9, 3.05, 1.1, and 0.3°C, for insulated tubing, at infusion rates 10, 30, 60, and 100 mL/minute, respectively). The results from this study could potentially be used to decrease the volume of fluid infused when inducing mild hypothermia with an infusion of cold fluids. PMID:26614854

  4. Therapeutic hypothermia and targeted temperature management in traumatic brain injury: Clinical challenges for successful translation.

    PubMed

    Dietrich, W Dalton; Bramlett, Helen M

    2016-06-01

    The use of therapeutic hypothermia (TH) and targeted temperature management (TTM) for severe traumatic brain injury (TBI) has been tested in a variety of preclinical and clinical situations. Early preclinical studies showed that mild reductions in brain temperature after moderate to severe TBI improved histopathological outcomes and reduced neurological deficits. Investigative studies have also reported that reductions in post-traumatic temperature attenuated multiple secondary injury mechanisms including excitotoxicity, free radical generation, apoptotic cell death, and inflammation. In addition, while elevations in post-traumatic temperature heightened secondary injury mechanisms, the successful implementation of TTM strategies in injured patients to reduce fever burden appear to be beneficial. While TH has been successfully tested in a number of single institutional clinical TBI studies, larger randomized multicenter trials have failed to demonstrate the benefits of therapeutic hypothermia. The use of TH and TTM for treating TBI continues to evolve and a number of factors including patient selection and the timing of the TH appear to be critical in successful trial design. Based on available data, it is apparent that TH and TTM strategies for treating severely injured patients is an important therapeutic consideration that requires more basic and clinical research. Current research involves the evaluation of alternative cooling strategies including pharmacologically-induced hypothermia and the combination of TH or TTM approaches with more selective neuroprotective or reparative treatments. This manuscript summarizes the preclinical and clinical literature emphasizing the importance of brain temperature in modifying secondary injury mechanisms and in improving traumatic outcomes in severely injured patients. This article is part of a Special Issue entitled SI:Brain injury and recovery. PMID:26746342

  5. Caring for patients receiving therapeutic hypothermia post cardiac arrest in the intensive care unit.

    PubMed

    Gardner, Glen; MacDonald, Sandra

    2013-01-01

    Survivors of ventricular fibrillation cardiac arrest have poor and often devastating neurological outcomes despite advances in resuscitation techniques and services (Bernard et al., 2002; Collins & Samworth, 2008). In an effort to increase survival rates, improve neurological outcomes and reduce mortality for surviving patients, clinical trials have shown that a mild state of therapeutic hypothermia (32 degrees C to 34 degrees C) has been linked to improved patient outcomes post cardiac arrest (Koran, 2008; Lee & Asare, 2010). Many hospitals in Canada currently use therapeutic hypothermia (TH), but the nursing care requires advanced nursing knowledge and skills. In an effort to prepare registered nurses to care for patients receiving TH, a specially designed education program was implemented at the Rouge Valley Health System Hospital (RVHS) in Ontario. Busy nurses need flexibility in the delivery of programs in the clinical setting, and this program was designed to meet that need with a combination of self-paced modules, lectures, discussions and a return demonstration. In this article, the authors discuss the nursing care of post cardiac arrest patients receiving TH, and the design and implementation of the education program.

  6. Automated analysis of background EEG and reactivity during therapeutic hypothermia in comatose patients after cardiac arrest.

    PubMed

    Noirhomme, Quentin; Lehembre, Rémy; Lugo, Zulay Del Rosario; Lesenfants, Damien; Luxen, André; Laureys, Steven; Oddo, Mauro; Rossetti, Andrea O

    2014-01-01

    Visual analysis of electroencephalography (EEG) background and reactivity during therapeutic hypothermia provides important outcome information, but is time-consuming and not always consistent between reviewers. Automated EEG analysis may help quantify the brain damage. Forty-six comatose patients in therapeutic hypothermia, after cardiac arrest, were included in the study. EEG background was quantified with burst-suppression ratio (BSR) and approximate entropy, both used to monitor anesthesia. Reactivity was detected through change in the power spectrum of signal before and after stimulation. Automatic results obtained almost perfect agreement (discontinuity) to substantial agreement (background reactivity) with a visual score from EEG-certified neurologists. Burst-suppression ratio was more suited to distinguish continuous EEG background from burst-suppression than approximate entropy in this specific population. Automatic EEG background and reactivity measures were significantly related to good and poor outcome. We conclude that quantitative EEG measurements can provide promising information regarding current state of the patient and clinical outcome, but further work is needed before routine application in a clinical setting.

  7. Early clinical prediction of neurological outcome following out of hospital cardiac arrest managed with therapeutic hypothermia

    PubMed Central

    Ruknuddeen, Mohammed Ishaq; Ramadoss, Rajaram; Rajajee, V.; Grzeskowiak, Luke E.; Rajagopalan, Ram E.

    2015-01-01

    Background: Therapeutic hypothermia (TH) may improve neurological outcome in comatose patients following out of hospital cardiac arrest (OHCA). The reliability of clinical prediction of neurological outcome following TH remains unclear. In particular, there is very limited data on survival and predictors of neurological outcome following TH for OHCA from resource-constrained settings in general and South Asia in specific. Objective: The objective was to identify factors predicting unfavorable neurological outcome at hospital discharge in comatose survivors of OHCA treated with hypothermia. Design: Retrospective chart review. Setting: Urban 200-bed hospital in Chennai, India. Methods: Predictors of unfavorable neurological outcome (cerebral performance category score [3–5]) at hospital discharge were evaluated among patients admitted between January 2006 and December 2012 following OHCA treated with TH. Hypothermia was induced with cold intravenous saline bolus, ice packs and cold-water spray with bedside fan. Predictors of unfavorable neurological outcome were examined through multivariate exact logistic regression analysis. Results: A total of 121 patients were included with 106/121 (87%) experiencing the unfavorable neurological outcome. Independent predictors of unfavorable neurological outcome included: Status myoclonus <24 h (odds ratio [OR] 21.79, 95% confidence interval [CI] 2.89-Infinite), absent brainstem reflexes (OR 50.09, 6.55-Infinite), and motor response worse than flexion on day 3 (OR 99.41, 12.21-Infinite). All 3 variables had 100% specificity and positive predictive value. Conclusion: Status myoclonus within 24 h, absence of brainstem reflexes and motor response worse than flexion on day 3 reliably predict unfavorable neurological outcome in comatose patients with OHCA treated with TH. PMID:26195855

  8. Cost-effective therapeutic hypothermia treatment device for hypoxic ischemic encephalopathy.

    PubMed

    Kim, John J; Buchbinder, Nathan; Ammanuel, Simon; Kim, Robert; Moore, Erika; O'Donnell, Neil; Lee, Jennifer K; Kulikowicz, Ewa; Acharya, Soumyadipta; Allen, Robert H; Lee, Ryan W; Johnston, Michael V

    2013-01-01

    Despite recent advances in neonatal care and monitoring, asphyxia globally accounts for 23% of the 4 million annual deaths of newborns, and leads to hypoxic-ischemic encephalopathy (HIE). Occurring in five of 1000 live-born infants globally and even more in developing countries, HIE is a serious problem that causes death in 25%-50% of affected neonates and neurological disability to at least 25% of survivors. In order to prevent the damage caused by HIE, our invention provides an effective whole-body cooling of the neonates by utilizing evaporation and an endothermic reaction. Our device is composed of basic electronics, clay pots, sand, and urea-based instant cold pack powder. A larger clay pot, lined with nearly 5 cm of sand, contains a smaller pot, where the neonate will be placed for therapeutic treatment. When the sand is mixed with instant cold pack urea powder and wetted with water, the device can extract heat from inside to outside and maintain the inner pot at 17°C for more than 24 hours with monitoring by LED lights and thermistors. Using a piglet model, we confirmed that our device fits the specific parameters of therapeutic hypothermia, lowering the body temperature to 33.5°C with a 1°C margin of error. After the therapeutic hypothermia treatment, warming is regulated by adjusting the amount of water added and the location of baby inside the device. Our invention uniquely limits the amount of electricity required to power and operate the device compared with current expensive and high-tech devices available in the United States. Our device costs a maximum of 40 dollars and is simple enough to be used in neonatal intensive care units in developing countries.

  9. Cost-effective therapeutic hypothermia treatment device for hypoxic ischemic encephalopathy

    PubMed Central

    Kim, John J; Buchbinder, Nathan; Ammanuel, Simon; Kim, Robert; Moore, Erika; O’Donnell, Neil; Lee, Jennifer K; Kulikowicz, Ewa; Acharya, Soumyadipta; Allen, Robert H; Lee, Ryan W; Johnston, Michael V

    2013-01-01

    Despite recent advances in neonatal care and monitoring, asphyxia globally accounts for 23% of the 4 million annual deaths of newborns, and leads to hypoxic-ischemic encephalopathy (HIE). Occurring in five of 1000 live-born infants globally and even more in developing countries, HIE is a serious problem that causes death in 25%–50% of affected neonates and neurological disability to at least 25% of survivors. In order to prevent the damage caused by HIE, our invention provides an effective whole-body cooling of the neonates by utilizing evaporation and an endothermic reaction. Our device is composed of basic electronics, clay pots, sand, and urea-based instant cold pack powder. A larger clay pot, lined with nearly 5 cm of sand, contains a smaller pot, where the neonate will be placed for therapeutic treatment. When the sand is mixed with instant cold pack urea powder and wetted with water, the device can extract heat from inside to outside and maintain the inner pot at 17°C for more than 24 hours with monitoring by LED lights and thermistors. Using a piglet model, we confirmed that our device fits the specific parameters of therapeutic hypothermia, lowering the body temperature to 33.5°C with a 1°C margin of error. After the therapeutic hypothermia treatment, warming is regulated by adjusting the amount of water added and the location of baby inside the device. Our invention uniquely limits the amount of electricity required to power and operate the device compared with current expensive and high-tech devices available in the United States. Our device costs a maximum of 40 dollars and is simple enough to be used in neonatal intensive care units in developing countries. PMID:23319871

  10. Therapeutic hypothermia in the postresuscitation patient: the development and implementation of an evidence-based protocol for the emergency department.

    PubMed

    Koran, Zeb

    2009-01-01

    Studies have shown that therapeutic hypothermia (TH) improves outcomes in patients who have experienced a cardiac arrest (; ). This article discusses TH and the process used by one emergency department to develop and implement an evidence-based protocol on TH for the postresuscitation patient.

  11. Still cooling after all these years: Meta-analysis of pre-clinical trials of therapeutic hypothermia for acute ischemic stroke.

    PubMed

    Dumitrascu, Oana M; Lamb, Jessica; Lyden, Patrick D

    2016-07-01

    Therapeutic hypothermia is the most potent neuroprotectant for experimental cerebral ischemia, illustrated in a 2007 meta-analysis published in this journal. To address recent therapeutic nihilism, we systematically reviewed recent experimental literature. Quality scoring showed considerable improvement in study design. Using several outcome measures in a variety of models and species, therapeutic hypothermia was protective compared with normothermia, with powerful and statistically significant normalized treatment effect sizes, in 60 papers comprising 216 comparisons. In the past 5 years, preclinical studies of ischemic stroke re-emphasize that therapeutic hypothermia is potently effective, justifying further development in larger human clinical trials. PMID:27089911

  12. Therapeutic Effects of Pharmacologically Induced Hypothermia against Traumatic Brain Injury in Mice

    PubMed Central

    Lee, Jin Hwan; Wei, Ling; Gu, Xiaohuan; Wei, Zheng; Dix, Thomas A.

    2014-01-01

    Abstract Preclinical and clinical studies have shown therapeutic potential of mild-to-moderate hypothermia for treatments of stroke and traumatic brain injury (TBI). Physical cooling in humans, however, is usually slow, cumbersome, and necessitates sedation that prevents early application in clinical settings and causes several side effects. Our recent study showed that pharmacologically induced hypothermia (PIH) using a novel neurotensin receptor 1 (NTR1) agonist, HPI-201 (also known as ABS-201), is efficient and effective in inducing therapeutic hypothermia and protecting the brain from ischemic and hemorrhagic stroke in mice. The present investigation tested another second-generation NTR1 agonist, HPI-363, for its hypothermic and protective effect against TBI. Adult male mice were subjected to controlled cortical impact (CCI) (velocity=3 m/sec, depth=1.0 mm, contact time=150 msec) to the exposed cortex. Intraperitoneal administration of HPI-363 (0.3 mg/kg) reduced body temperature by 3–5°C within 30–60 min without triggering a shivering defensive reaction. An additional two injections sustained the hypothermic effect in conscious mice for up to 6 h. This PIH treatment was initiated 15, 60, or 120 min after the onset of TBI, and significantly reduced the contusion volume measured 3 days after TBI. HPI-363 attenuated caspase-3 activation, Bax expression, and TUNEL-positive cells in the pericontusion region. In blood–brain barrier assessments, HPI-363 ameliorated extravasation of Evans blue dye and immunoglobulin G, attenuated the MMP-9 expression, and decreased the number of microglia cells in the post-TBI brain. HPI-363 decreased the mRNA expression of tumor necrosis factor-α and interleukin-1β (IL-1β), but increased IL-6 and IL-10 levels. Compared with TBI control mice, HPI-363 treatments improved sensorimotor functional recovery after TBI. These findings suggest that the second generation NTR-1 agonists, such as HPI-363, are efficient

  13. Short term outcome of therapeutic hypothermia in term infants with moderate to severe hypoxic ischaemic encephalopathy; the Sungai Buloh experience.

    PubMed

    See, K C; Jamal, S J Syed; Chiam, M L

    2012-06-01

    This analysis is a case-series to document the outcome of term newborns with hypoxic ischaemic encephalopathy (HIE), enrolled into total body hypothermia therapy, in a tertiary neonatal unit in Malaysia. The method used to achieve total body hypothermia is a novel method using just environmental temperature, without the need of expensive equipment. A total of 17 babies were eligible to be included in this study, from the 1st of January 2010 to the 31st of December 2010. 14 out of 15 babies who had Stage 2 HIE had no neurological deficit at follow-up. All Stage 3 HIE babies passed away. Allowing for the small sample size, we can conclude that total body hypothermia therapy is feasible and is a safe treatment modality for HIE Stage 2 babies in a Malaysian setting, by manipulating environmental temperature to achieve therapeutic hypothermia. Further work is needed to determine the long-term outcome of passive cooling total body hypothermia in Stage 2 HIE babies in Malaysia.

  14. Therapeutic hypothermia on transport: providing safe and effective cooling therapy as the link between birth hospital and the neonatal intensive care unit.

    PubMed

    Schierholz, Elizabeth

    2014-10-01

    Therapeutic hypothermia as a neuroprotective strategy in neonates is an established standard of care for infants with hypoxic-ischemic encephalopathy (HIE) in tertiary care neonatal intensive care units (NICUs). To maximize the neuroprotective effect in infants with HIE, hypothermia is initiated as soon as possible after birth. Many infants who would benefit from therapeutic hypothermia are not born at centers that have intensive care units or offer therapeutic hypothermia and are thus transported to a tertiary care center with a NICU, offering specialty services of therapeutic hypothermia and pediatric neurology. The neonatal transport team plays a significant role in the management of these critically ill infants. Clinical research provides data for safe and effective management of these infants during therapeutic hypothermia in the NICU; however, there are no evidence-based clinical guidelines for management before and during transport. The establishment of evidence-based guidelines for cooling before and during transport will facilitate early recognition of infants who would benefit from therapeutic hypothermia therapy, and decrease delay in initiation of therapy. Careful assessment, monitoring, and intervention by the transport team are critical to provide appropriate care and ensure safe transport of these infants.

  15. Therapeutic hypothermia attenuates tissue damage and cytokine expression after traumatic brain injury by inhibiting necroptosis in the rat

    PubMed Central

    Liu, Tao; Zhao, Dong-xu; Cui, Hua; Chen, Lei; Bao, Ying-hui; Wang, Yong; Jiang, Ji-yao

    2016-01-01

    Necroptosis has been shown as an alternative form of cell death in many diseases, but the detailed mechanisms of the neuron loss after traumatic brain injury (TBI) in rodents remain unclear. To investigate whether necroptosis is induced after TBI and gets involved in the neuroprotecton of therapeutic hypothermia on the TBI, we observed the pathological and biochemical change of the necroptosis in the fluid percussion brain injury (FPI) model of the rats. We found that receptor-interacting protein (RIP) 1 and 3, and mixed lineage kinase domain-like protein (MLKL), the critical downstream mediators of necroptosis recently identified in vivo, as well as HMGB1 and the pro-inflammation cytokines TNF-α, IL-6 and IL-18, were increased at an early phase (6 h) in cortex after TBI. Posttraumatic hypothermia (33 °C) led to the decreases in the necroptosis regulators, inflammatory factors and brain tissue damage in rats compared with normothermia-treated TBI animals. Immunohistochemistry studies showed that posttraumatic hypothermia also decreased the necroptosis-associated proteins staining in injured cortex and hippocampal CA1. Therefore, we conclude that the RIP1/RIP3-MLKL-mediated necroptosis occurs after experimental TBI and therapeutic hypothermia may protect the injured central nervous system from tissue damage and the inflammatory responses by targeting the necroptosis signaling after TBI. PMID:27080932

  16. [Subcutaneous fat necrosis and persistent hypercalcaemia in a newborn treated with therapeutic neonatal hypothermia. A case report].

    PubMed

    Martínez de Zabarte Fernández, José M; Laliena Aznar, Sara; Corella Aznar, Elena; Cuadrado Piqueras, Laura; Oliván del Cacho, María J; Pinillos Pisón, Raquel

    2016-02-01

    Therapeutic hypothermia is the current standard treatment in newborns with moderate to severe hypoxic-ischemic encephalopathy, changing the outcome of these children. It is considered a safe technique with almost no side effects. A possible adverse side event is subcutaneous fat necrosis, which is an acute self-limiting panniculitis that develops during the first weeks of life. We report a case of a newborn at term suffering hypoxic-ischemic encephalopathy with a generalized multiform erythematous rash and firm and indurated plaques over the back, buttocks and extremities on his 12th day of life after being treated with therapeutic hypothermia. Histopathological study after skin punchbiopsy confirmed the suspicion of subcutaneous fat necrosis. The infant developed asymptomatic moderate hypercalcaemia within the first month of life, which was treated with intravenous fluids and diuretics. Serum calcium levels decreased and normalized in 3 months, with progressive disappearance of skin lesions.

  17. Evidence for the Therapeutic Efficacy of Either Mild Hypothermia or Oxygen Radical Scavengers after Repetitive Mild Traumatic Brain Injury

    PubMed Central

    Miyauchi, Takashi; Wei, Enoch P.

    2014-01-01

    Abstract Repetitive brain injury, particularly that occurring with sporting-related injuries, has recently garnered increased attention in both the clinical and public settings. In the laboratory, we have demonstrated the adverse axonal and vascular consequences of repetitive brain injury and have demonstrated that moderate hypothermia and/or FK506 exerted protective effects after repetitive mild traumatic brain injury (mTBI) when administered within a specific time frame, suggesting a range of therapeutic modalities to prevent a dramatic exacerbation. In this communication, we revisit the utility of targeted therapeutic intervention to seek the minimal level of hypothermia needed to achieve protection while probing the role of oxygen radicals and their therapeutic targeting. Male Sprague-Dawley rats were subjected to repetitive mTBI by impact acceleration injury. Mild hypothermia (35°C, group 2), superoxide dismutase (group 3), and Tempol (group 4) were employed as therapeutic interventions administered 1 h after the repetitive mTBI. To assess vascular function, cerebral vascular reactivity to acetylcholine was evaluated 3 and 4 h after the repetitive mTBI, whereas to detect the burden of axonal damage, amyloid precursor protein (APP) density in the medullospinal junction was measured. Whereas complete impairment of vascular reactivity was observed in group 1 (without intervention), significant preservation of vascular reactivity was found in the other groups. Similarly, whereas remarkable increase in the APP-positive axon was observed in group 1, there were no significant increases in the other groups. Collectively, these findings indicate that even mild hypothermia or the blunting free radical damage, even when performed in a delayed period, is protective in repetitive mTBI. PMID:24341607

  18. Early Implementation of THAM for ICP Control: Therapeutic Hypothermia Avoidance and Reduction in Hypertonics/Hyperosmotics

    PubMed Central

    Zeiler, F. A.; Gillman, L. M.; Teitelbaum, J.; West, M.

    2014-01-01

    Background. Tromethamine (THAM) has been demonstrated to reduce intracranial pressure (ICP). Early consideration for THAM may reduce the need for other measures for ICP control. Objective. To describe 4 cases of early THAM therapy for ICP control and highlight the potential to avoid TH and paralytics and achieve reduction in sedation and hypertonic/hyperosmotic agent requirements. Methods. We reviewed the charts of 4 patients treated with early THAM for ICP control. Results. We identified 2 patients with aneurysmal subarachnoid hemorrhage (SAH) and 2 with traumatic brain injury (TBI) receiving early THAM for ICP control. The mean time to initiation of THAM therapy was 1.8 days, with a mean duration of 5.3 days. In all patients, after 6 to 12 hours of THAM administration, ICP stability was achieved, with reduction in requirements for hypertonic saline and hyperosmotic agents. There was a relative reduction in mean hourly hypertonic saline requirements of 89.1%, 96.1%, 82.4%, and 97.0% for cases 1, 2, 3, and 4, respectively, comparing pre- to post-THAM administration. Mannitol, therapeutic hypothermia, and paralytics were avoided in all patients. Conclusions. Early administration of THAM for ICP control could potentially lead to the avoidance of other ICP directed therapies. Prospective studies of early THAM administration are warranted. PMID:25544901

  19. Cerebral oxygen metabolism in neonatal hypoxic ischemic encephalopathy during and after therapeutic hypothermia.

    PubMed

    Dehaes, Mathieu; Aggarwal, Alpna; Lin, Pei-Yi; Rosa Fortuno, C; Fenoglio, Angela; Roche-Labarbe, Nadège; Soul, Janet S; Franceschini, Maria Angela; Grant, P Ellen

    2014-01-01

    Pathophysiologic mechanisms involved in neonatal hypoxic ischemic encephalopathy (HIE) are associated with complex changes of blood flow and metabolism. Therapeutic hypothermia (TH) is effective in reducing the extent of brain injury, but it remains uncertain how TH affects cerebral blood flow (CBF) and metabolism. Ten neonates undergoing TH for HIE and seventeen healthy controls were recruited from the NICU and the well baby nursery, respectively. A combination of frequency domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) systems was used to non-invasively measure cerebral hemodynamic and metabolic variables at the bedside. Results showed that cerebral oxygen metabolism (CMRO2i) and CBF indices (CBFi) in neonates with HIE during TH were significantly lower than post-TH and age-matched control values. Also, cerebral blood volume (CBV) and hemoglobin oxygen saturation (SO2) were significantly higher in neonates with HIE during TH compared with age-matched control neonates. Post-TH CBV was significantly decreased compared with values during TH whereas SO2 remained unchanged after the therapy. Thus, FDNIRS-DCS can provide information complimentary to SO2 and can assess individual cerebral metabolic responses to TH. Combined FDNIRS-DCS parameters improve the understanding of the underlying physiology and have the potential to serve as bedside biomarkers of treatment response and optimization.

  20. Therapeutic hypothermia for cardiovascular collapse and severe respiratory distress after amniotic fluid embolism.

    PubMed

    Ocegueda-Pacheco, Cynthia; García, J Carlos; Varon, Joseph; Polderman, Kees H

    2014-06-01

    Amniotic fluid embolism (AFE) is one of the most catastrophic complications that can occur during pregnancy or in the immediate postpartum period, frequently complicated by profound shock and cardiovascular collapse as well as severe respiratory distress. Therapeutic hypothermia (TH) is now commonly used to improve neurological outcomes after various types of hypoxic injury and is widely used in the treatment of postanoxic injury after cardiac arrest (CA). To our knowledge, no studies have evaluated whether TH could be effectively used in AFE, and its use for this indication has not been described previously. We describe the case of a 32-year-old woman, who developed clinical manifestations of AFE and suffered a CA in the 29th week of her pregnancy. She received prolonged CPR (40 minutes until ROSC) and remained comatose. TH was induced and maintained for a total of 60 hours using an endovascular device, followed by controlled rewarming and maintenance of strict normothermia. The patient survived and was neurologically intact (CPC 1) at 6 months of follow up.

  1. The effects of physiological thermoregulation on the efficacy of surface cooling for therapeutic hypothermia.

    PubMed

    Kalra, Mayank; Bahrami, Majid; Sparrey, Carolyn J

    2015-03-01

    Therapeutic hypothermia is rapidly becoming an integral part of post-resuscitative care for post-cardiac arrest and neurotrauma patients. Despite the significant impact of thermoregulation on core temperature drop during rapid cooling, current mathematical models for thermoregulation have not been validated for hypothermic conditions. A geometrically accurate 3D model of an upper leg was developed by segmenting anatomical images from the visible human dataset into fat, muscle, bone, and blood vessels. Thermoregulation models from literature were implemented in the model. The numerical model results were compared with surface cooling experiments. There was a good agreement of simulation results with experimental data at 18 °C water immersion using existing models. However, at lower temperatures, the model parameter values needed to be significantly altered to account for cold-induced vasodilation in the superficial blood vessels and variation in muscle perfusion to match experimental observations. Additionally, results indicate that thermal mass has a dominant effect on cooling rate; therefore, uniform cooling over a large surface area will be more effective than targeted cooling of areas with superficial blood vessels. This study is the first to analyze the effects of thermoregulation in hypothermic conditions and identify unique thermoregulatory effects that differentiate hypothermic and normal conditions.

  2. Development of a therapeutic hypothermia protocol: implementation for postcardiac arrest STEMI patients.

    PubMed

    Dixon, Mari-Newton; Keasling, Michelle

    2014-01-01

    Therapeutic hypothermia (TH) reduces neurologic injury and mortality in out-of-hospital cardiac arrest survivors. Myocardial infarction (MI) is one of the main causes of cardiac arrest and primary percutaneous coronary intervention (PCI) is recommended as initial treatment for patients who present with acute ST-segment elevated MI (STEMI). Cape Fear Valley Medical Center (CFVMC) was the only designated PCI center in the state of North Carolina without a TH protocol. The purpose of this quality improvement initiative was to develop and implement a TH protocol for postcardiac arrest STEMI patients at CFVMC. The existing STEMI process was adapted to include the use of TH for STEMI patients who presented from out-of-hospital cardiac arrest. Steps to development of the protocol included creation of TH STEMI flow map, reallocation of nursing staff, exploration of cooling methods and equipment options, development of a evidence-based physician order set, creation of nursing documentation process and competency assessment, organization of educational sessions, and approval through multiple hospital committees. The development of a postarrest STEMI TH protocol involved multiple disciplines and required approval from several committees. Lack of physician and nursing knowledge of the protocol proved to be the greatest challenge. The TH protocol is a step forward in implementing evidence-based practice and improving the quality of postresuscitation care provided to postcardiac arrest STEMI patients.

  3. Outcomes in Cardiac Arrest Patients due to Toxic Exposure Treated with Therapeutic Hypothermia.

    PubMed

    Modisett, Katharine L; Walsh, Steven J; Heffner, Alan C; Pearson, David A; Kerns, William

    2016-09-01

    The incidence and outcome of patients who undergo therapeutic hypothermia (TH) after toxin-induced cardiac arrest (TICA) is not previously described. Our study aimed to describe the incidence, epidemiologic characteristics, and outcomes of patients who experience TICA in a dedicated clinical pathway for post-cardiac arrest care between November 2007 and February 2013. All patients were treated in an evidence-based clinical pathway that included TH. Database and medical records were independently reviewed by investigators to ascertain TICA. TICA was defined as cardiac arrest (CA) directly and immediately caused by a xenobiotic exposure. All patients were enrolled at Carolinas Medical Center, an urban 874-bed teaching hospital that serves as a regional cardiac resuscitation center. All patients were adult victims of cardiac arrest who had obtained return of spontaneous circulation and were enrolled in a clinical pathway for post-cardiac arrest care that included TH. Three hundred eighty-nine patients underwent treatment following CA during the study period and 48 (12 %) were deemed TICA. Patients who suffered TICA were slightly younger, less likely to have an initial shockable rhythm, and less likely to receive bystander CPR as compared to non-toxic cases. TICA accounted for a significant proportion of patients in this study. Additional, larger studies are needed to fully elucidate the optimal role for TH in TICA.

  4. Feasibility Study Evaluating Therapeutic Hypothermia for Refractory Status Epilepticus in Children.

    PubMed

    Buttram, Sandra D W; Au, Alicia K; Koch, Joshua; Lidsky, Karen; McBain, Kristin; O'Brien, Nicole; Zielinski, Brandon A; Bell, Michael J

    2015-12-01

    Pediatric refractory status epilepticus (RSE) is a neurological emergency with significant morbidity and mortality, which lacks consensus regarding diagnosis and treatment(s). Therapeutic hypothermia (TH) is an effective treatment for RSE in preclinical models and small series. In addition, TH is a standard care for adults after cardiac arrest and neonates with hypoxic-ischemic encephalopathy. The purpose of this study was to identify the feasibility of a study of pediatric RSE within a research group (Pediatric Neurocritical Care Research Group [PNCRG]). Pediatric intensive care unit (PICU) admissions at seven centers were prospectively screened from October 2012 to July 2013 for RSE. Experts within the PNCRG estimated that clinicians would be unwilling to enroll a child, unless the child required at least two different antiepileptic medications and a continuous infusion of another antiepileptic medication with ongoing electrographic seizure activity for ≥2 hours after continuous infusion initiation. Data for children meeting the above inclusion criteria were collected, including the etiology of RSE, history of epilepsy, and maximum dose of continuous antiepileptic infusions. There were 8113 PICU admissions over a cumulative 52 months (October 2012-July 2013) at seven centers. Of these, 69 (0.85%) children met inclusion criteria. Twenty children were excluded due to acute diagnoses affected by TH, contraindications to TH, or lack of commitment to aggressive therapies. Sixteen patients had seizure cessation within 2 hours, resulting in 33 patients who had inadequate seizure control after 2 hours and a continuous antiepileptic infusion. Midazolam (21/33, 64%) and pentobarbital (5/33, 15%) were the most common infusions with a wide maximum dose range. More than one infusion was required for seizure control in four patients. There are substantial numbers of subjects at clinical sites within the PNCRG with RSE that would meet the proposed inclusion criteria for a

  5. Rewarming from therapeutic hypothermia induces cortical neuron apoptosis in a swine model of neonatal hypoxic-ischemic encephalopathy.

    PubMed

    Wang, Bing; Armstrong, Jillian S; Lee, Jeong-Hoo; Bhalala, Utpal; Kulikowicz, Ewa; Zhang, Hui; Reyes, Michael; Moy, Nicole; Spicer, Dawn; Zhu, Junchao; Yang, Zeng-Jin; Koehler, Raymond C; Martin, Lee J; Lee, Jennifer K

    2015-05-01

    The consequences of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy are poorly understood. Adverse effects from suboptimal rewarming could diminish neuroprotection from hypothermia. Therefore, we tested whether rewarming is associated with apoptosis. Piglets underwent hypoxia-asphyxia followed by normothermic or hypothermic recovery at 2 hours. Hypothermic groups were divided into those with no rewarming, rewarming at 0.5 °C/hour, or rewarming at 4 °C/hour. Neurodegeneration at 29 hours was assessed by hematoxylin and eosin staining, TUNEL assay, and immunoblotting for cleaved caspase-3. Rewarmed piglets had more apoptosis in motor cortex than did those that remained hypothermic after hypoxia-asphyxia. Apoptosis in piriform cortex was greater in hypoxic-asphyxic, rewarmed piglets than in naive/sham piglets. Caspase-3 inhibitor suppressed apoptosis with rewarming. Rapidly rewarmed piglets had more caspase-3 cleavage in cerebral cortex than did piglets that remained hypothermic or piglets that were rewarmed slowly. We conclude that rewarming from therapeutic hypothermia can adversely affect the newborn brain by inducing apoptosis through caspase mechanisms.

  6. Rewarming from therapeutic hypothermia induces cortical neuron apoptosis in a swine model of neonatal hypoxic-ischemic encephalopathy.

    PubMed

    Wang, Bing; Armstrong, Jillian S; Lee, Jeong-Hoo; Bhalala, Utpal; Kulikowicz, Ewa; Zhang, Hui; Reyes, Michael; Moy, Nicole; Spicer, Dawn; Zhu, Junchao; Yang, Zeng-Jin; Koehler, Raymond C; Martin, Lee J; Lee, Jennifer K

    2015-05-01

    The consequences of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy are poorly understood. Adverse effects from suboptimal rewarming could diminish neuroprotection from hypothermia. Therefore, we tested whether rewarming is associated with apoptosis. Piglets underwent hypoxia-asphyxia followed by normothermic or hypothermic recovery at 2 hours. Hypothermic groups were divided into those with no rewarming, rewarming at 0.5 °C/hour, or rewarming at 4 °C/hour. Neurodegeneration at 29 hours was assessed by hematoxylin and eosin staining, TUNEL assay, and immunoblotting for cleaved caspase-3. Rewarmed piglets had more apoptosis in motor cortex than did those that remained hypothermic after hypoxia-asphyxia. Apoptosis in piriform cortex was greater in hypoxic-asphyxic, rewarmed piglets than in naive/sham piglets. Caspase-3 inhibitor suppressed apoptosis with rewarming. Rapidly rewarmed piglets had more caspase-3 cleavage in cerebral cortex than did piglets that remained hypothermic or piglets that were rewarmed slowly. We conclude that rewarming from therapeutic hypothermia can adversely affect the newborn brain by inducing apoptosis through caspase mechanisms. PMID:25564240

  7. Outcome and current status of therapeutic hypothermia after out-of-hospital cardiac arrest in Korea using data from the Korea Hypothermia Network registry

    PubMed Central

    Lee, Byung Kook; Park, Kyu Nam; Kang, Gu Hyun; Kim, Kyung Hwan; Kim, Giwoon; Kim, Won Young; Min, Jin Hong; Park, Yooseok; Park, Jung Bae; Suh, Gil Joon; Son, Yoo Dong; Shin, Jonghwan; Oh, Joo Suk; You, Yeon Ho; Lee, Dong Hoon; Lee, Jong Seok; Lim, Hoon; Jang, Tae Chang; Cho, Gyu Chong; Cho, In Soo; Cha, Kyoung Chul; Choi, Seung Pill; Choi, Wook Jin; Han, Chul

    2014-01-01

    Objective Therapeutic hypothermia (TH) has become the standard strategy for reducing brain damage in the postresuscitation period. The aim of this study was to investigate current TH performance and outcomes in out-of-hospital cardiac arrest (OHCA) survivors using data from the Korean Hypothermia Network (KORHN) registry. Methods We used the KORHN registry, a web-based multicenter registry that includes 24 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TH between 2007 and 2012 were included. The primary outcomes were neurological outcome at hospital discharge and in-hospital mortality. The secondary outcomes were TH performance and adverse events during TH. Results A total of 930 patients were included, of whom 556 (59.8%) survived to discharge and 249 (26.8%) were discharged with good neurologic outcomes. The median time from return of spontaneous circulation (ROSC) to the start of TH was 101 minutes (interquartile range [IQR], 46 to 200 minutes). The induction, maintenance, and rewarming durations were 150 minutes (IQR, 80 to 267 minutes), 1,440 minutes (IQR, 1,290 to 1,440 minutes), and 708 minutes (IQR, 420 to 900 minutes), respectively. The time from the ROSC to coronary angiography was 1,045 hours (IQR, 121 to 12,051 hours). Hyperglycemia (46.3%) was the most frequent adverse event. Conclusion More than one-quarter of the OHCA survivors (26.8%) were discharged with good neurologic outcomes. TH performance was appropriately managed in terms of the factors related to its timing, including cooling start time and rewarming duration. PMID:27752548

  8. Drug-induced mild therapeutic hypothermia obtained by administration of a transient receptor potential vanilloid type 1 agonist

    PubMed Central

    2010-01-01

    Background The use of mechanical/physical devices for applying mild therapeutic hypothermia is the only proven neuroprotective treatment for survivors of out of hospital cardiac arrest. However, this type of therapy is cumbersome and associated with several side-effects. We investigated the feasibility of using a transient receptor potential vanilloid type 1 (TRPV1) agonist for obtaining drug-induced sustainable mild hypothermia. Methods First, we screened a heterogeneous group of TRPV1 agonists and secondly we tested the hypothermic properties of a selected candidate by dose-response studies. Finally we tested the hypothermic properties in a large animal. The screening was in conscious rats, the dose-response experiments in conscious rats and in cynomologus monkeys, and the finally we tested the hypothermic properties in conscious young cattle (calves with a body weight as an adult human). The investigated TRPV1 agonists were administered by continuous intravenous infusion. Results Screening: Dihydrocapsaicin (DHC), a component of chili pepper, displayed a desirable hypothermic profile with regards to the duration, depth and control in conscious rats. Dose-response experiments: In both rats and cynomologus monkeys DHC caused a dose-dependent and immediate decrease in body temperature. Thus in rats, infusion of DHC at doses of 0.125, 0.25, 0.50, and 0.75 mg/kg/h caused a maximal ΔT (°C) as compared to vehicle control of -0.9, -1.5, -2.0, and -4.2 within approximately 1 hour until the 6 hour infusion was stopped. Finally, in calves the intravenous infusion of DHC was able to maintain mild hypothermia with ΔT > -3°C for more than 12 hours. Conclusions Our data support the hypothesis that infusion of dihydrocapsaicin is a candidate for testing as a primary or adjunct method of inducing and maintaining therapeutic hypothermia. PMID:20932337

  9. PRACTICAL ASPECTS OF THERAPEUTIC HYPOTHERMIA IN NEONATES WITH HYPOXIC ISCHEMIC ENCEPHALOPATHY--QUESTIONS AND ANSWERS. PART I. PROVIDING NEWBORN CARE BEFORE AND DURING TRANSFER TO THE REFERENCE CENTER.

    PubMed

    Gulczyńska, Ewa; Gadzinowski, Janusz

    2015-01-01

    The first decade of the 21st century saw the worldwide spread of therapeutic hypothermia as a beneficial therapeutic procedure in neonates with hypoxic-ischemic encephalopathy. New guidelines for the resuscitation of newborns confirm that therapeutic hypothermia should be the standard method of treatment offered to neonates with acute perinatal hypoxia. The quality of care which an asphyxiated newborn receives during and immediately after resuscitation, as well as the mode of preparation for transport, can have a significant impact on improving the outcome, but it can also result in the deterioration of neonates treated with hypothermia. Since to a considerable degree the therapeutic effect depends on the time of beginning the cooling procedure, there is no reason to unnecessarily delay treatment. For this purpose, neonatologists or pediatricians from referring hospitals who do not have the equipment for hypothermia can and even should begin the cooling process while waiting for the arrival of the neonatal transport team. In that short period a number of concerns arise regarding the optimal methods of child care and preparation for transport to the hypothermia center. The authors discuss the possibility of initiating cooling before transportation using simple, so called low-tech cooling methods, the possible risks associated with the incidence of hyperthermia, difficulties in the interpretation of the eligibility criteria, supportive therapy, and the problems connected with the communication process between the medical team and the parents. The aspects that have been analyzed should be helpful for professionals in neonatal wards, outside hypothermia centers.

  10. PRACTICAL ASPECTS OF THERAPEUTIC HYPOTHERMIA IN NEONATES WITH HYPOXIC ISCHEMIC ENCEPHALOPATHY--QUESTIONS AND ANSWERS. PART I. PROVIDING NEWBORN CARE BEFORE AND DURING TRANSFER TO THE REFERENCE CENTER.

    PubMed

    Gulczyńska, Ewa; Gadzinowski, Janusz

    2015-01-01

    The first decade of the 21st century saw the worldwide spread of therapeutic hypothermia as a beneficial therapeutic procedure in neonates with hypoxic-ischemic encephalopathy. New guidelines for the resuscitation of newborns confirm that therapeutic hypothermia should be the standard method of treatment offered to neonates with acute perinatal hypoxia. The quality of care which an asphyxiated newborn receives during and immediately after resuscitation, as well as the mode of preparation for transport, can have a significant impact on improving the outcome, but it can also result in the deterioration of neonates treated with hypothermia. Since to a considerable degree the therapeutic effect depends on the time of beginning the cooling procedure, there is no reason to unnecessarily delay treatment. For this purpose, neonatologists or pediatricians from referring hospitals who do not have the equipment for hypothermia can and even should begin the cooling process while waiting for the arrival of the neonatal transport team. In that short period a number of concerns arise regarding the optimal methods of child care and preparation for transport to the hypothermia center. The authors discuss the possibility of initiating cooling before transportation using simple, so called low-tech cooling methods, the possible risks associated with the incidence of hyperthermia, difficulties in the interpretation of the eligibility criteria, supportive therapy, and the problems connected with the communication process between the medical team and the parents. The aspects that have been analyzed should be helpful for professionals in neonatal wards, outside hypothermia centers. PMID:26958686

  11. Treatment temperature and insult severity influence the neuroprotective effects of therapeutic hypothermia

    PubMed Central

    Wood, Thomas; Osredkar, Damjan; Puchades, Maja; Maes, Elke; Falck, Mari; Flatebø, Torun; Walløe, Lars; Sabir, Hemmen; Thoresen, Marianne

    2016-01-01

    Therapeutic hypothermia (HT) is standard care for moderate and severe neonatal hypoxic-ischaemic encephalopathy (HIE), the leading cause of permanent brain injury in term newborns. However, the optimal temperature for HT is still unknown, and few preclinical studies have compared multiple HT treatment temperatures. Additionally, HT may not benefit infants with severe encephalopathy. In a neonatal rat model of unilateral hypoxia-ischaemia (HI), the effect of five different HT temperatures was investigated after either moderate or severe injury. At postnatal-day seven, rat pups underwent moderate or severe HI followed by 5 h at normothermia (37 °C), or one of five HT temperatures: 33.5 °C, 32 °C, 30 °C, 26 °C, and 18 °C. One week after treatment, neuropathological analysis of hemispheric and hippocampal area loss, and CA1 hippocampal pyramidal neuron count, was performed. After moderate injury, a significant reduction in hemispheric and hippocampal loss on the injured side, and preservation of CA1 pyramidal neurons, was seen in the 33.5 °C, 32 °C, and 30 °C groups. Cooling below 33.5 °C did not provide additional neuroprotection. Regardless of treatment temperature, HT was not neuroprotective in the severe HI model. Based on these findings, and previous experience translating preclinical studies into clinical application, we propose that milder cooling should be considered for future clinical trials. PMID:26997257

  12. Implementation in Buenos Aires City of a program to prevent neurological damage caused by hypoxic-ischemic encephalopathy: Therapeutic hypothermia.

    PubMed

    Valera, Mariana; Berazategui, Juan Pablo; Saa, Gladys; Olmo Herrera, Carolina; Sepúlveda, Teresa; Buraschi, María Fernanda; Gacio, Sebastián; Villalba, Cristina; Beloso, Inés; Basso, Graciela; Carlo, Waldemar; Tavosnanska, Jorge

    2015-10-01

    Therapeutic hypothermia is the standard of care for hypoxic-ischemic encephalopathy (HIE). This treatment was implemented at a regional level by the perinatal network of the City of Buenos Aires. The following are the objectives of this article: 1. To describe the implementation of the network's hypothermia treatment program; 2. To report treatment-associated complications, adverse events and mortality. The program was implemented in stages: 1) 2009-2010. Training and instruction on how to use the equipment. 2) 20102014. Treatment and follow-up of patients with moderate or severe HIE. Up to October 2014, 27 newborn infants received hypothermia treatment with moderate (n= 15) and severe (n= 12) HIE. None of the patients died during treatment. Three newborn infants were lost to follow-up. Among the 16 survivors older than one year old, three have severe neurological disability. Program implementation was plausible. It is imperative to train health care providers on how to identify patients with HIE. PMID:26294149

  13. Prolonged mild therapeutic hypothermia versus fever control with tight hemodynamic monitoring and slow rewarming in patients with severe traumatic brain injury: a randomized controlled trial.

    PubMed

    Maekawa, Tsuyoshi; Yamashita, Susumu; Nagao, Seigo; Hayashi, Nariyuki; Ohashi, Yasuo

    2015-04-01

    Although mild therapeutic hypothermia is an effective neuroprotective strategy for cardiac arrest/resuscitated patients, and asphyxic newborns, recent randomized controlled trials (RCTs) have equally shown good neurological outcome between targeted temperature management at 33 °C versus 36 °C, and have not shown consistent benefits in patients with traumatic brain injury (TBI). We aimed to determine the effect of therapeutic hypothermia, while avoiding some limitations of earlier studies, which included patient selection based on Glasgow coma scale (GCS), delayed initiation of cooling, short duration of cooling, inter-center variation in patient care, and relatively rapid rewarming. We conducted a multicenter RCT in patients with severe TBI (GCS 4-8). Patients were randomly assigned (2:1 allocation ratio) to either therapeutic hypothermia (32-34 °C, n = 98) or fever control (35.5-37 °C, n = 50). Patients with therapeutic hypothermia were cooled as soon as possible for ≥ 72 h and rewarmed at a rate of <1 °C/day. All patients received tight hemodynamic monitoring under intensive neurological care. The Glasgow Outcome Scale was assessed at 6 months by physicians who were blinded to the treatment allocation. The overall rates of poor neurological outcomes were 53% and 48% in the therapeutic hypothermia and fever control groups, respectively. There were no significant differences in the likelihood of poor neurological outcome (relative risk [RR] 1.24, 95% confidence interval [CI] 0.62-2.48, p = 0.597) or mortality (RR 1.82, 95% CI 0.82-4.03, p = 0.180) between the two groups. We concluded that tight hemodynamic management and slow rewarming, together with prolonged therapeutic hypothermia (32-34 °C) for severe TBI, did not improve the neurological outcomes or risk of mortality compared with strict temperature control (35.5-37 °C). PMID:25099730

  14. Prolonged mild therapeutic hypothermia versus fever control with tight hemodynamic monitoring and slow rewarming in patients with severe traumatic brain injury: a randomized controlled trial.

    PubMed

    Maekawa, Tsuyoshi; Yamashita, Susumu; Nagao, Seigo; Hayashi, Nariyuki; Ohashi, Yasuo

    2015-04-01

    Although mild therapeutic hypothermia is an effective neuroprotective strategy for cardiac arrest/resuscitated patients, and asphyxic newborns, recent randomized controlled trials (RCTs) have equally shown good neurological outcome between targeted temperature management at 33 °C versus 36 °C, and have not shown consistent benefits in patients with traumatic brain injury (TBI). We aimed to determine the effect of therapeutic hypothermia, while avoiding some limitations of earlier studies, which included patient selection based on Glasgow coma scale (GCS), delayed initiation of cooling, short duration of cooling, inter-center variation in patient care, and relatively rapid rewarming. We conducted a multicenter RCT in patients with severe TBI (GCS 4-8). Patients were randomly assigned (2:1 allocation ratio) to either therapeutic hypothermia (32-34 °C, n = 98) or fever control (35.5-37 °C, n = 50). Patients with therapeutic hypothermia were cooled as soon as possible for ≥ 72 h and rewarmed at a rate of <1 °C/day. All patients received tight hemodynamic monitoring under intensive neurological care. The Glasgow Outcome Scale was assessed at 6 months by physicians who were blinded to the treatment allocation. The overall rates of poor neurological outcomes were 53% and 48% in the therapeutic hypothermia and fever control groups, respectively. There were no significant differences in the likelihood of poor neurological outcome (relative risk [RR] 1.24, 95% confidence interval [CI] 0.62-2.48, p = 0.597) or mortality (RR 1.82, 95% CI 0.82-4.03, p = 0.180) between the two groups. We concluded that tight hemodynamic management and slow rewarming, together with prolonged therapeutic hypothermia (32-34 °C) for severe TBI, did not improve the neurological outcomes or risk of mortality compared with strict temperature control (35.5-37 °C).

  15. First Use of a New Device for Administration of Buspirone and Acetaminophen to Suppress Shivering During Therapeutic Hypothermia

    PubMed Central

    Parker, Braden; Wesselhoff, Kelly; Lyons, Neal; Kulstad, Erik

    2016-01-01

    Therapeutic hypothermia or targeted temperature management has been used after cardiac arrest to improve neurological outcomes and mortality. However, a side effect of temperature modulation is a centrally mediated shivering response. The Columbia Anti-Shivering Protocol sets up a systematic method of intravenous (IV) and oral medication escalation to suppress this response and preserve the benefits of this therapy. We present the case of a 59-year-old male who began shivering after therapeutic hypothermia for cardiac arrest, leading to a persistent rise in core temperature despite adequate sedation. He was also found to have gastric contents similar to coffee grounds through nasogastric tube suction. The shivering was effectively suppressed and the rising core temperature plateaued using rectal acetaminophen and buspirone administered by means of a novel device, the Macy Catheter. Also, when used in conjunction with other protocol-driven medications, the patient was able to achieve a core temperature of 33°C. The Macy Catheter appears to be a useful approach to rectally administer buspirone and acetaminophen, using an easy-to-place, nonsterile atraumatic device that requires no radiographic confirmation of placement. PMID:26807775

  16. First Use of a New Device for Administration of Buspirone and Acetaminophen to Suppress Shivering During Therapeutic Hypothermia.

    PubMed

    Honasoge, Akilesh; Parker, Braden; Wesselhoff, Kelly; Lyons, Neal; Kulstad, Erik

    2016-03-01

    Therapeutic hypothermia or targeted temperature management has been used after cardiac arrest to improve neurological outcomes and mortality. However, a side effect of temperature modulation is a centrally mediated shivering response. The Columbia Anti-Shivering Protocol sets up a systematic method of intravenous (IV) and oral medication escalation to suppress this response and preserve the benefits of this therapy. We present the case of a 59-year-old male who began shivering after therapeutic hypothermia for cardiac arrest, leading to a persistent rise in core temperature despite adequate sedation. He was also found to have gastric contents similar to coffee grounds through nasogastric tube suction. The shivering was effectively suppressed and the rising core temperature plateaued using rectal acetaminophen and buspirone administered by means of a novel device, the Macy Catheter. Also, when used in conjunction with other protocol-driven medications, the patient was able to achieve a core temperature of 33°C. The Macy Catheter appears to be a useful approach to rectally administer buspirone and acetaminophen, using an easy-to-place, nonsterile atraumatic device that requires no radiographic confirmation of placement. PMID:26807775

  17. Induction of therapeutic hypothermia by pharmacological modulation of temperature-sensitive TRP channels: theoretical framework and practical considerations.

    PubMed

    Feketa, Viktor V; Marrelli, Sean P

    2015-01-01

    Therapeutic hypothermia has emerged as a remarkably effective method of neuroprotection from ischemia and is being increasingly used in clinics. Accordingly, it is also a subject of considerable attention from a basic scientific research perspective. One of the fundamental problems, with which current studies are concerned, is the optimal method of inducing hypothermia. This review seeks to provide a broad theoretical framework for approaching this problem, and to discuss how a novel promising strategy of pharmacological modulation of the thermosensitive ion channels fits into this framework. Various physical, anatomical, physiological and molecular aspects of thermoregulation, which provide the foundation for this text, have been comprehensively reviewed and will not be discussed exhaustively here. Instead, the first part of the current review, which may be helpful for a broader readership outside of thermoregulation research, will build on this existing knowledge to outline possible opportunities and research directions aimed at controlling body temperature. The second part, aimed at a more specialist audience, will highlight the conceptual advantages and practical limitations of novel molecular agents targeting thermosensitive Transient Receptor Potential (TRP) channels in achieving this goal. Two particularly promising members of this channel family, namely TRP melastatin 8 (TRPM8) and TRP vanilloid 1 (TRPV1), will be discussed in greater detail.

  18. Induction of therapeutic hypothermia by pharmacological modulation of temperature-sensitive TRP channels: theoretical framework and practical considerations

    PubMed Central

    Feketa, Viktor V; Marrelli, Sean P

    2015-01-01

    Therapeutic hypothermia has emerged as a remarkably effective method of neuroprotection from ischemia and is being increasingly used in clinics. Accordingly, it is also a subject of considerable attention from a basic scientific research perspective. One of the fundamental problems, with which current studies are concerned, is the optimal method of inducing hypothermia. This review seeks to provide a broad theoretical framework for approaching this problem, and to discuss how a novel promising strategy of pharmacological modulation of the thermosensitive ion channels fits into this framework. Various physical, anatomical, physiological and molecular aspects of thermoregulation, which provide the foundation for this text, have been comprehensively reviewed and will not be discussed exhaustively here. Instead, the first part of the current review, which may be helpful for a broader readership outside of thermoregulation research, will build on this existing knowledge to outline possible opportunities and research directions aimed at controlling body temperature. The second part, aimed at a more specialist audience, will highlight the conceptual advantages and practical limitations of novel molecular agents targeting thermosensitive Transient Receptor Potential (TRP) channels in achieving this goal. Two particularly promising members of this channel family, namely TRP melastatin 8 (TRPM8) and TRP vanilloid 1 (TRPV1), will be discussed in greater detail. PMID:27227027

  19. Microdialysis as Clinical Evaluation of Therapeutic Hypothermia in Rat Subdural Hematoma Model.

    PubMed

    Yokobori, Shoji; Spurlock, Markus S; Lee, Stephanie W; Gajavelli, Shyam; Bullock, Ross M

    2016-01-01

    Cerebral microdialysis (MD) is a fine laboratory technique which has been established for studying physiological, pharmacological, and pathological changes in the experimental studies of traumatic brain injury (TBI). This technique has also been well translated and widely applied to clinical bedside monitoring to provide pathophysiological analysis in severe TBI patients. The MD technique is thus well suited for straightforward translation from basic science to clinical application.In this chapter, we describe our evaluation of MD method in acute subdural hematoma (ASDH) rat model. With 100 kDa cut-off microdialysis membrane, we could measure several biomarkers such as ubiquitin carboxy hydrolase L1 (UCH-L1), a neuronal marker and glial fibrillary acidic protein (GFAP), and a glial marker in extracellular fluid. In this experiment, we could detect that the peak of extracellular UCH-L1 in the early hypothermia group was significantly lower than in the normothermia group. Also, in the late phase of reperfusion (>2.5 h after decompression), extracellular GFAP in the early hypothermia group was lower than in the normothermia. These data thus suggested that early, preoperatively induced hypothermia could mediate the reduction of neuronal and glial damage in the reperfusion phase of ischemia/reperfusion brain injury.Microdialysis allows for the direct measurement of extracellular molecules in an attempt to characterize metabolic derangements before they become clinically relevant. Advancements in technology have allowed for the bedside assay of multiple markers of ischemia and metabolic dysfunction, and the applications for traumatic brain injury have been well established. As clinicians become more comfortable with these tools their widespread use and potential for clinical impact with continue to rise. PMID:27604731

  20. Neuroprotective effect of therapeutic hypothermia versus standard care alone after convulsive status epilepticus: protocol of the multicentre randomised controlled trial HYBERNATUS.

    PubMed

    Legriel, Stephane; Pico, Fernando; Tran-Dinh, Yves-Roger; Lemiale, Virginie; Bedos, Jean-Pierre; Resche-Rigon, Matthieu; Cariou, Alain

    2016-12-01

    Convulsive status epilepticus (CSE) is a major medical emergency associated with a 50 % morbidity rate. CSE guidelines have recommended prompt management for many years, but there is no evidence to date that they have significantly improved practices or outcomes. Developing neuroprotective strategies for use after CSE holds promise for diminishing morbidity and mortality rates. Hypothermia has been shown to afford neuroprotection in various health conditions. We therefore designed a trial to determine whether 90-day outcomes in mechanically ventilated patients with CSE requiring management in the intensive care unit (ICU) are improved by early therapeutic hypothermia (32-34 °C) for 24 h with propofol sedation. We are conducting a multicentre, open-label, parallel-group, randomised, controlled trial (HYBERNATUS) of potential neuroprotective effects of therapeutic hypothermia and routine propofol sedation started within 8 h after CSE onset in ICU patients requiring mechanical ventilation. Included patients are allocated to receive therapeutic hypothermia (32-34 °C) plus standard care or standard care alone. We plan to enrol 270 patients in 11 ICUs. An interim analysis is scheduled after the inclusion of 135 patients. The main study objective is to evaluate the effectiveness of therapeutic hypothermia (32-34 °C) for 24 h in diminishing 90-day morbidity and mortality (defined as a Glasgow Outcome Scale score <5). The HYBERNATUS trial is expected to a decreased proportion of patients with a Glasgow Outcome Scale score lower than 5 after CSE requiring ICU admission and mechanical ventilation. Trial registration Clinicaltrials.gov identifier NCT01359332 (registered on 23 May 2011).

  1. Prehospital stroke care

    PubMed Central

    Saver, Jeffrey L.; Starkman, Sidney; Lees, Kennedy R.; Endres, Matthias

    2013-01-01

    Brain cells die rapidly after stroke and any effective treatment must start as early as possible. In clinical routine, the tight time–outcome relationship continues to be the major limitation of therapeutic approaches: thrombolysis rates remain low across many countries, with most patients being treated at the late end of the therapeutic window. In addition, there is no neuroprotective therapy available, but some maintain that this concept may be valid if administered very early after stroke. Recent innovations have opened new perspectives for stroke diagnosis and treatment before the patient arrives at the hospital. These include stroke recognition by dispatchers and paramedics, mobile telemedicine for remote clinical examination and imaging, and integration of CT scanners and point-of-care laboratories in ambulances. Several clinical trials are now being performed in the prehospital setting testing prehospital delivery of neuroprotective, antihypertensive, and thrombolytic therapy. We hypothesize that these new approaches in prehospital stroke care will not only shorten time to treatment and improve outcome but will also facilitate hyperacute stroke research by increasing the number of study participants within an ultra-early time window. The potentials, pitfalls, and promises of advanced prehospital stroke care and research are discussed in this review. PMID:23897876

  2. [Accidental hypothermia].

    PubMed

    Soteras Martínez, Iñigo; Subirats Bayego, Enric; Reisten, Oliver

    2011-07-01

    Accidental hypothermia is an infrequent and under-diagnosed pathology, which causes fatalities every year. Its management requires thermometers to measure core temperature. An esophageal probe may be used in a hospital situation, although in moderate hypothermia victims epitympanic measurement is sufficient. Initial management involves advance life support and body rewarming. Vigorous movements can trigger arrhythmia which does not use to respond to medication or defibrillation until the body reaches 30°C. External, passive rewarming is the method of choice for mild hypothermia and a supplementary method for moderate or severe hypothermia. Active external rewarming is indicated for moderate or severe hypothermia or mild hypothermia that has not responded to passive rewarming. Active internal rewarming is indicated for hemodynamically stable patients suffering moderate or severe hypothermia. Patients with severe hypothermia, cardiac arrest or with a potassium level below 12 mmol/l may require cardiopulmonary bypass treatment.

  3. Setting Up an Efficient Therapeutic Hypothermia Team in Conscious ST Elevation Myocardial Infarction Patients: A UK Heart Attack Center Experience

    PubMed Central

    Islam, Shahed; Hampton-Till, James; MohdNazri, Shah; Watson, Noel; Gudde, Ellie; Gudde, Tom; Kelly, Paul A.; Tang, Kare H.

    2015-01-01

    Patients presenting with ST elevation myocardial infarction (STEMI) are routinely treated with percutaneous coronary intervention to restore blood flow in the occluded artery to reduce infarct size (IS). However, there is evidence to suggest that the restoration of blood flow can cause further damage to the myocardium through reperfusion injury (RI). Recent research in this area has focused on minimizing damage to the myocardium caused by RI. Therapeutic hypothermia (TH) has been shown to be beneficial in animal models of coronary artery occlusion in reducing IS caused by RI if instituted early in an ischemic myocardium. Data in humans are less convincing to date, although exploratory analyses suggest that there is significant clinical benefit in reducing IS if TH can be administered at the earliest recognition of ischemia in anterior myocardial infarction. The Essex Cardiothoracic Centre is the first UK center to have participated in administering TH in conscious patients presenting with STEMI as part of the COOL-AMI case series study. In this article, we outline our experience of efficiently integrating conscious TH into our primary percutaneous intervention program to achieve 18 minutes of cooling duration before reperfusion, with no significant increase in door-to-balloon times, in the setting of the clinical trial. PMID:26154447

  4. Relationship Between Cerebral Oxygenation and Metabolism During Rewarming in Newborn Infants After Therapeutic Hypothermia Following Hypoxic-Ischemic Brain Injury.

    PubMed

    Mitra, Subhabrata; Bale, Gemma; Meek, Judith; Uria-Avellanal, Cristina; Robertson, Nicola J; Tachtsidis, Ilias

    2016-01-01

    Therapeutic hypothermia (TH) has become a standard of care following hypoxic ischemic encephalopathy (HIE). After TH, body temperature is brought back to 37 °C over 14 h. Lactate/N-acetylasperatate (Lac/NAA) peak area ratio on proton magnetic resonance spectroscopy ((1)H MRS) is the best available outcome biomarker following HIE. We hypothesized that broadband near infrared spectroscopy (NIRS) measured changes in the oxidation state of cytochrome-c-oxidase concentration (Δ[oxCCO]) and cerebral hemodynamics during rewarming would relate to Lac/NAA. Broadband NIRS and systemic data were collected during rewarming from 14 infants following HIE over a mean period of 12.5 h. (1)H MRS was performed on day 5-9. Heart rate increased by 20/min during rewarming while blood pressure and peripheral oxygen saturation (SpO2) remained stable. The relationship between mitochondrial metabolism and oxygenation (measured as Δ[oxCCO] and Δ[HbD], respectively) was calculated by linear regression analysis. This was reviewed in three groups: Lac/NAA values <0.5, 0.5-1, >1. Mean regression coefficient (r (2)) values in these groups were 0.41 (±0.27), 0.22 (±0.21) and 0.01, respectively. The relationship between mitochondrial metabolism and oxygenation became impaired with rising Lac/NAA. Cardiovascular parameters remained stable during rewarming.

  5. Setting Up an Efficient Therapeutic Hypothermia Team in Conscious ST Elevation Myocardial Infarction Patients: A UK Heart Attack Center Experience.

    PubMed

    Islam, Shahed; Hampton-Till, James; MohdNazri, Shah; Watson, Noel; Gudde, Ellie; Gudde, Tom; Kelly, Paul A; Tang, Kare H; Davies, John R; Keeble, Thomas R

    2015-12-01

    Patients presenting with ST elevation myocardial infarction (STEMI) are routinely treated with percutaneous coronary intervention to restore blood flow in the occluded artery to reduce infarct size (IS). However, there is evidence to suggest that the restoration of blood flow can cause further damage to the myocardium through reperfusion injury (RI). Recent research in this area has focused on minimizing damage to the myocardium caused by RI. Therapeutic hypothermia (TH) has been shown to be beneficial in animal models of coronary artery occlusion in reducing IS caused by RI if instituted early in an ischemic myocardium. Data in humans are less convincing to date, although exploratory analyses suggest that there is significant clinical benefit in reducing IS if TH can be administered at the earliest recognition of ischemia in anterior myocardial infarction. The Essex Cardiothoracic Centre is the first UK center to have participated in administering TH in conscious patients presenting with STEMI as part of the COOL-AMI case series study. In this article, we outline our experience of efficiently integrating conscious TH into our primary percutaneous intervention program to achieve 18 minutes of cooling duration before reperfusion, with no significant increase in door-to-balloon times, in the setting of the clinical trial.

  6. The effects of therapeutic hypothermia on cerebral metabolism in neonates with hypoxic-ischemic encephalopathy: An in vivo 1H-MR spectroscopy study.

    PubMed

    Wisnowski, Jessica L; Wu, Tai-Wei; Reitman, Aaron J; McLean, Claire; Friedlich, Philippe; Vanderbilt, Douglas; Ho, Eugenia; Nelson, Marvin D; Panigrahy, Ashok; Blüml, Stefan

    2016-06-01

    Therapeutic hypothermia has emerged as the first empirically supported therapy for neuroprotection in neonates with hypoxic-ischemic encephalopathy (HIE). We used magnetic resonance spectroscopy ((1)H-MRS) to characterize the effects of hypothermia on energy metabolites, neurotransmitters, and antioxidants. Thirty-one neonates with HIE were studied during hypothermia and after rewarming. Metabolite concentrations (mmol/kg) were determined from the thalamus, basal ganglia, cortical grey matter, and cerebral white matter. In the thalamus, phosphocreatine concentrations were increased by 20% during hypothermia when compared to after rewarming (3.49 ± 0.88 vs. 2.90 ± 0.65, p < 0.001) while free creatine concentrations were reduced to a similar degree (3.00 ± 0.50 vs. 3.74 ± 0.85, p < 0.001). Glutamate (5.33 ± 0.82 vs. 6.32 ± 1.12, p < 0.001), aspartate (3.39 ± 0.66 vs. 3.87 ± 1.19, p < 0.05), and GABA (0.92 ± 0.36 vs. 1.19 ± 0.41, p < 0.05) were also reduced, while taurine (1.39 ± 0.52 vs. 0.79 ± 0.61, p < 0.001) and glutathione (2.23 ± 0.41 vs. 2.09 ± 0.33, p < 0.05) were increased. Similar patterns were observed in other brain regions. These findings support that hypothermia improves energy homeostasis by decreasing the availability of excitatory neurotransmitters, and thereby, cellular energy demand.

  7. The effects of therapeutic hypothermia on cerebral metabolism in neonates with hypoxic-ischemic encephalopathy: An in vivo 1H-MR spectroscopy study.

    PubMed

    Wisnowski, Jessica L; Wu, Tai-Wei; Reitman, Aaron J; McLean, Claire; Friedlich, Philippe; Vanderbilt, Douglas; Ho, Eugenia; Nelson, Marvin D; Panigrahy, Ashok; Blüml, Stefan

    2016-06-01

    Therapeutic hypothermia has emerged as the first empirically supported therapy for neuroprotection in neonates with hypoxic-ischemic encephalopathy (HIE). We used magnetic resonance spectroscopy ((1)H-MRS) to characterize the effects of hypothermia on energy metabolites, neurotransmitters, and antioxidants. Thirty-one neonates with HIE were studied during hypothermia and after rewarming. Metabolite concentrations (mmol/kg) were determined from the thalamus, basal ganglia, cortical grey matter, and cerebral white matter. In the thalamus, phosphocreatine concentrations were increased by 20% during hypothermia when compared to after rewarming (3.49 ± 0.88 vs. 2.90 ± 0.65, p < 0.001) while free creatine concentrations were reduced to a similar degree (3.00 ± 0.50 vs. 3.74 ± 0.85, p < 0.001). Glutamate (5.33 ± 0.82 vs. 6.32 ± 1.12, p < 0.001), aspartate (3.39 ± 0.66 vs. 3.87 ± 1.19, p < 0.05), and GABA (0.92 ± 0.36 vs. 1.19 ± 0.41, p < 0.05) were also reduced, while taurine (1.39 ± 0.52 vs. 0.79 ± 0.61, p < 0.001) and glutathione (2.23 ± 0.41 vs. 2.09 ± 0.33, p < 0.05) were increased. Similar patterns were observed in other brain regions. These findings support that hypothermia improves energy homeostasis by decreasing the availability of excitatory neurotransmitters, and thereby, cellular energy demand. PMID:26661180

  8. [Therapeutic hypothermia after cardiac arrest. A cold intravenous fluid, a cooling helmet and a cooling blanket efficiently reduce body temperature].

    PubMed

    Friberg, Hans; Nielsen, Niklas; Karlsson, Torbjörn; Cronberg, Tobias; Widner, Håkan; Englund, Elisabet; Ersson, Anders

    2004-07-22

    Two controlled randomized trials have shown that mild systemic hypothermia after cardiac arrest is beneficial for neurological outcome and one of the studies shows an improved survival rate. A pilot study was performed to evaluate a model of induced hypothermia after cardiac arrest, using cold intravenous fluids and surface cooling with a cold helmet and a coldwater blanket (Thermowrap). The main purpose was to evaluate our cooling method regarding efficacy, safety and usability. Five unconscious patients after cardiac arrest were treated with induced hypothermia of whom three survived with good recovery to six-month follow up. Two patients died in the ICU without regaining consciousness. There were no adverse events during treatment. We conclude that our method is reasonably fast compared to other published methods, it is easy to perform and it offers a good temperature control during cooling and rewarming. Routines for evaluating prognosis and neurological outcome after cardiac arrest and hypothermia treatment need to be revised. PMID:15314936

  9. Higher Achieved Mean Arterial Pressure During Therapeutic Hypothermia is Not Associated with Neurologically Intact Survival Following Cardiac Arrest

    PubMed Central

    Young, Michael N.; Hollenbeck, Ryan D.; Pollock, Jeremy S.; Giuseffi, Jennifer L.; Wang, Li; Harrell, Frank E.; McPherson, John A.

    2015-01-01

    Introduction To determine if higher achieved mean arterial blood pressure (MAP) during treatment with therapeutic hypothermia (TH) is associated with neurologically intact survival following cardiac arrest. Methods Retrospective analysis of a prospectively collected cohort of 188 consecutive patients treated with TH in the cardiovascular intensive care unit of an academic tertiary care hospital. Results Neurologically intact survival was observed in 73/188 (38.8%) patients at hospital discharge and in 48/162 (29.6%) patients at a median follow up interval of 3 months. Patients in shock at the time of admission had lower baseline MAP at the initiation of TH (81 versus 87 mmHg; p=0.002), but had similar achieved MAP during TH (80.3 versus 83.7 mmHg; p=0.11). Shock on admission was associated with poor survival (18% versus 52%; p<0.001). Vasopressor use among all patients was common (84.6%) and was not associated with increased mortality. A multivariable analysis including age, initial rhythm, time to return of spontaneous circulation, baseline MAP and achieved MAP did not demonstrate a relationship between MAP achieved during TH and poor neurologic outcome at hospital discharge (OR 1.28, 95% CI 0.40–4.06; p=0.87) or at outpatient follow up (OR 1.09, 95% CI 0.32–3.75; p=0.976). Conclusion We did not observe a relationship between higher achieved MAP during TH and neurologically intact survival. However, shock at the time of admission was clearly associated with poor outcomes in our study population. These data do not support the use of vasopressors to artificially increase MAP in the absence of shock. There is a need for prospective, randomized trials to further define the optimum blood pressure target during treatment with TH. PMID:25541429

  10. Therapeutic Hypothermia for Refractory Status Epilepticus in a Child with Malignant Migrating Partial Seizures of Infancy and SCN1A Mutation: A Case Report

    PubMed Central

    Shein, Steven L.; Reynolds, Thomas Q.; Gedela, Satyanarayana; Kochanek, Patrick M.

    2012-01-01

    Status epilepticus (SE) is a common indication for neurocritical care and can be refractory to standard measures. Refractory SE (RSE) is associated with high morbidity and mortality. Unconventional therapies may be utilized in certain cases, including therapeutic hypothermia (TH), bumetanide, and the ketogenic diet. However, the literature describing the use of such therapies in RSE is limited. Details of a case of TH for RSE in an infant with malignant migrating partial seizures of infancy were obtained from the medical record. A 4-month-old child developed SE that was refractory to treatment with concurrent midazolam, phenobarbital, fosphenytoin, topiramate, levetiracetam, folinic acid, and pyridoxal-5-phosphate. This led to progressive implementation of three unconventional therapies: TH, bumetanide, and the ketogentic diet. Electrographic seizures ceased for the entirety of a 43-hour period of TH with a target rectal temperature of 33.0°C–34.0°C. No adverse effects of hypothermia were noted other than a single episode of asymptomatic hypokalemia. Seizures recurred 10 hours after rewarming was begun and did not abate with reinstitution of hypothermia. No effect was seen with administration of bumetanide. Seizures were controlled long-term within 48 hours of institution of the ketogenic diet. TH and the ketogenic diet may be effective for treating RSE in children. PMID:23667778

  11. Accidental hypothermia.

    PubMed

    Corneli, Howard M

    2012-05-01

    Accidental hypothermia has produced many cases of intact survival even after prolonged cardiac arrest, but it is also often fatal. In recent years, alterations in resuscitation care that sometimes confused or discouraged resuscitation teams have largely been supplanted by an emphasis on safe, rapid, effective rewarming. Rewarming decisions and even the simple recognition of hypothermia remain challenging. This review seeks to update and demystify some of these challenges. PMID:22561323

  12. Hibernation, Hypothermia and a Possible Therapeutic "Shifted Homeostasis" Induced by Central Activation of A1 Adenosine Receptor (A1AR).

    PubMed

    Tupone, Domenico; Cetas, Justin S; Morrison, Shaun F

    2016-04-01

    The positive outcome that hypothermia contributes to brain and cardiac protection following ischemia has stimulated research in the development of pharmacological approaches to induce a hypothermic/hypometabolic state. Pharmacological manipulation of central autonomic thermoregulatory circuits could represent a potential target for the induction of a hypothermic state. Here we present a brief description of the CNS thermoregulatory centers and how the manipulation of these circuits can be useful in the treatment of pathological conditions such as stroke or brain hemorrhage. PMID:27333659

  13. Comparison of cold crystalloid and colloid infusions for induction of therapeutic hypothermia in a porcine model of cardiac arrest

    PubMed Central

    2013-01-01

    Introduction Large-volume cold intravenous infusion of crystalloids has been used for induction of therapeutic hypothermia after cardiac arrest. However, the effectiveness of cold colloids has not been evaluated. Therefore, we performed an experimental study to investigate the cooling effect of cold normal saline compared to colloid solution in a porcine model of ventricular fibrillation. Methods Ventricular fibrillation was induced for 15 minutes in 22 anesthetized domestic pigs. After spontaneous circulation was restored, the animals were randomized to receive either 45 ml/kg of 1°C cold normal saline (Group A, 9 animals); or 45 ml/kg of 1°C cold colloid solution (Voluven®, 6% hydroxyethyl starch 130/0.4 in 0.9% NaCl) during 20 minutes (Group B, 9 animals); or to undergo no cooling intervention (Group C, 4 animals). Then, the animals were observed for 90 minutes. Cerebral, rectal, intramuscular, pulmonary artery, and subcutaneous fat body temperatures (BT) were recorded. In the mechanical ex-vivo sub study we added a same amount of cold normal saline or colloid into the bath of normal saline and calculated the area under the curve (AUC) for induced temperature changes. Results Animals treated with cold fluids achieved a significant decrease of BT at all measurement sites, whereas there was a consistent significant spontaneous increase in group C. At the time of completion of infusion, greater decrease in pulmonary artery BT and cerebral BT in group A compared to group B was detected (−2.1 ± 0.3 vs. -1.6 ± 0.2°C, and −1.7 ± 0.4 vs. -1.1 ± 0.3°C, p < 0.05, respectively). AUC analysis of the decrease of cerebral BT revealed a more vigorous cooling effect in group A compared to group B (−91 ± 22 vs. -68 ± 23°C/min, p = 0.046). In the mechanical sub study, AUC analysis of the induced temperature decrease of cooled solution revealed that addition of normal saline led to more intense cooling than colloid solution (

  14. Therapeutic Hypothermia Reduces Intracranial Pressure and Partial Brain Oxygen Tension in Patients with Severe Traumatic Brain Injury: Preliminary Data from the Eurotherm3235 Trial.

    PubMed

    Flynn, Liam M C; Rhodes, Jonathan; Andrews, Peter J D

    2015-09-01

    Traumatic brain injury (TBI) is a significant cause of disability and death and a huge economic burden throughout the world. Much of the morbidity associated with TBI is attributed to secondary brain injuries resulting in hypoxia and ischemia after the initial trauma. Intracranial hypertension and decreased partial brain oxygen tension (PbtO2) are targeted as potentially avoidable causes of morbidity. Therapeutic hypothermia (TH) may be an effective intervention to reduce intracranial pressure (ICP), but could also affect cerebral blood flow (CBF). This is a retrospective analysis of prospectively collected data from 17 patients admitted to the Western General Hospital, Edinburgh. Patients with an ICP >20 mmHg refractory to initial therapy were randomized to standard care or standard care and TH (intervention group) titrated between 32°C and 35°C to reduce ICP. ICP and PbtO2 were measured using the Licox system and core temperature was recorded through rectal thermometer. Data were analyzed at the hour before cooling, the first hour at target temperature, 2 consecutive hours at target temperature, and after 6 hours of hypothermia. There was a mean decrease in ICP of 4.3±1.6 mmHg (p<0.04) from 15.7 to 11.4 mmHg, from precooling to the first epoch of hypothermia in the intervention group (n=9) that was not seen in the control group (n=8). A decrease in ICP was maintained throughout all time periods. There was a mean decrease in PbtO2 of 7.8±3.1 mmHg (p<0.05) from 30.2 to 22.4 mmHg, from precooling to stable hypothermia, which was not seen in the control group. This research supports others in demonstrating a decrease in ICP with temperature, which could facilitate a reduction in the use of hyperosmolar agents or other stage II interventions. The decrease in PbtO2 is not below the suggested treatment threshold of 20 mmHg, but might indicate a decrease in CBF.

  15. Handling Hypothermia.

    ERIC Educational Resources Information Center

    Saho, S. Bamba

    1996-01-01

    Presents a unit on the body's response to hypothermia. Includes activities in which students measure the amount of heat absorbed by a white piece of cloth and a black piece of the same material, use cooperative-learning techniques to design a graphic organizer that explains metabolic responses to cold stress, and study the effect of temperature on…

  16. Better lactate clearance associated with good neurologic outcome in survivors who treated with therapeutic hypothermia after out-of-hospital cardiac arrest

    PubMed Central

    2013-01-01

    Introduction Several methods have been proposed to evaluate neurological outcome in out-of-hospital cardiac arrest (OHCA) patients. Blood lactate has been recognized as a reliable prognostic marker for trauma, sepsis, or cardiac arrest. The objective of this study was to examine the association between initial lactate level or lactate clearance and neurologic outcome in OHCA survivors who were treated with therapeutic hypothermia. Methods This retrospective cohort study included patients who underwent protocol-based 24-hour therapeutic hypothermia after OHCA between January 2010 and March 2012. Serum lactate levels were measured at the start of therapy (0 hours), and after 6 hours, 12 hours, 24 hours, 48 hours and 72 hours. The 6 hour and 12 hour lactate clearance were calculated afterwards. Patients’ neurologic outcome was assessed at one month after cardiac arrest; good neurological outcome was defined as Cerebral Performance Category one or two. The primary outcome was an association between initial lactate level and good neurologic outcome. The secondary outcome was an association between lactate clearance and good neurologic outcome in patients with initial lactate level >2.5 mmol/l. Results Out of the 76 patients enrolled, 34 (44.7%) had a good neurologic outcome. The initial lactate level showed no significant difference between good and poor neurologic outcome groups (6.07 ±4 .09 mmol/L vs 7.13 ± 3.99 mmol/L, P = 0.42), However, lactate levels at 6 hours, 12 hours, 24 hours, and 48 hours in the good neurologic outcome group were lower than in the poor neurologic outcome group (3.81 ± 2.81 vs 6.00 ± 3.22 P <0.01, 2.95 ± 2.07 vs 5.00 ± 3.49 P <0.01, 2.17 ± 1.24 vs 3.86 ± 3.92 P <0.01, 1.57 ± 1.02 vs 2.21 ± 1.35 P = 0.03, respectively). The secondary analysis showed that the 6-hour and 12-hour lactate clearance was higher for good neurologic outcome patients (35.3 ± 34.6% vs 6.89

  17. Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study

    PubMed Central

    2014-01-01

    Background Severe traumatic brain injury (TBI) is a significant health concern and a major burden for society. The period between trauma event and hospital admission in an emergency department (ED) could be a determinant for secondary brain injury and early survival. The aim was to investigate the relationship between prehospital factors associated with secondary brain injury (arterial hypotension, hypoxemia, hypothermia) and the outcomes of mortality and impaired consciousness of survivors at 14 days. Methods A multicenter, prospective cohort study was performed in dedicated trauma centres of Switzerland. Adults with severe TBI (Abbreviated Injury Scale score of head region (HAIS) >3) were included. Main outcome measures were death and impaired consciousness (Glasgow Coma Scale (GCS) ≤13) at 14 days. The associations between risk factors and outcome were assessed with univariate and multivariate regression models. Results 589 patients were included, median age was 55 years (IQR 33, 70). The median GCS in ED was 4 (IQR 3-14), with abnormal pupil reaction in 167 patients (29.2%). Median ISS was 25 (IQR 21, 34). Three hundred seven patients sustained their TBI from falls (52.1%) and 190 from a road traffic accidents (32.3%). Median time from Out-of-hospital Emergency Medical Service (OHEMS) departure on scene to arrival in ED was 50 minutes (IQR 37-72); 451 patients had a direct admission (76.6%). Prehospital hypotension was observed in 24 (4.1%) patients, hypoxemia in 73 (12.6%) patients and hypothermia in 146 (24.8%). Prehospital hypotension and hypothermia (apart of age and trauma severity) was associated with mortality. Prehospital hypoxemia (apart of trauma severity) was associated with impaired consciousness; indirect admission was a protective factor. Conclusion Mortality and impaired consciousness at 14 days do not have the same prehospital risk factors; prehospital hypotension and hypothermia is associated with mortality, and prehospital hypoxemia with

  18. Impact of presenting rhythm on short- and long-term neurological outcome in comatose survivors of cardiac arrest treated with therapeutic hypothermia

    PubMed Central

    Terman, Samuel W; Hume, Benjamin; Meurer, William J; Silbergleit, Robert

    2014-01-01

    Objective To compare short- and long-term neurological outcomes in comatose survivors of out-of-hospital cardiac arrest (OHCA) treated with mild therapeutic hypothermia (MTH) presenting with non-shockable (nSR) versus shockable (SR) initial rhythms. Design Retrospective cohort study. Setting ED and ICU of an academic hospital. Patients One hundred twenty-three consecutive post-OHCA adults (57 nSR, 67 SR) treated with therapeutic hypothermia between 2006 and 2012. Measurements and Main Results Data were collected from electronic health records. Neurological outcomes were dichotomized by Cerebral Performance Category at discharge and 6-12 month follow-up and analyzed via multivariable logistic regressions. Groups were similar, except nSR patients were more likely to have a history of diabetes mellitus (p = 0.01), be dialysis-dependent (p = 0.01), and not have bystander CPR (p = 0.05). At discharge, 3/57 (5%) patients with nSR versus 28/66 (42%) with SR had a favorable outcome (unadjusted OR 0.08, 95% CI 0.02-0.3; adjusted OR 0.1, 95% CI 0.03-0. 4). At follow-up, 4/55 (7%) versus 29/60 (48%) of patients with nSR and SR respectively had a favorable CPC (OR 0.08, 95% CI 0.03-0.3; adjusted OR 0.09, 95% CI 0.09-0.3). Among those surviving hospitalization, neurological outcome was more likely at long-term follow-up than at hospital discharge for both groups (OR 2.5, 95% CI 1.3-4.7; adjusted 2.9, 1.4-6.2). No significant interaction between changes in neurological status over time and presenting rhythm was seen (p=0.93). Conclusions These data indicate an association between initial nSR and significantly worse short- and long-term outcomes in patients treated with MTH. Among survivors, neurological status significantly improved over time for all patients and SR patients, and tended to improve over time for the small number of nSR patients who survived beyond hospitalization. No significant interaction between changes in neurological status over time and presenting rhythm

  19. Sodium Nitroprusside-enhanced Cardiopulmonary Resuscitation Facilitates Intra-Arrest Therapeutic Hypothermia in a Porcine Model of Prolonged Ventricular Fibrillation

    PubMed Central

    Debaty, Guillaume; Matsuura, Timothy R.; Bartos, Jason A.; Rees, Jennifer N.; McKnite, Scott H.; Lick, Michael; Boucher, François; Yannopoulos, Demetris

    2014-01-01

    Objectives The aim of this study was to assess the effect of Sodium Nitroprusside-enhanced Cardiopulmonary Resuscitation (SNPeCPR) on heat exchange during surface cooling. We hypothesized that SNPeCPR would decrease the time required to reach brain temperature < 35 °C compared to Active Compression-Decompression plus Impedance Threshold Device (ACD-ITD) CPR alone, in the setting of intra-CPR cooling. We further hypothesized that the addition of epinephrine during SNPeCPR would mitigate heat exchange. Design Prospective randomized animal investigation. Setting Preclinical animal laboratory. Subjects Female farm pigs (n = 28) Interventions After 10 minutes of untreated VF, animals were randomized to 3 different protocols: SNPeCPR (n = 8), SNPeCPR plus epinephrine (SNPeCPR+EPI, n = 10), and ACD-ITD alone (Control, n = 10). All animals received surface cooling at the initiation of CPR. SNPeCPR included ACD-ITD plus abdominal binding and 2 mg of SNP at 1, 4 and 8 minutes of CPR. No epinephrine was used during CPR in the SNPeCPR group. Control and SNPeCPR+EPI groups received 0.5 mg of epinephrine at minute 4.5 and 9 of CPR. Defibrillation occurred after 10 minutes of CPR. After ROSC, an Arctic Sun® was applied at maximum cooling on all animals. The primary endpoint was the time required to reach brain temperature < 35 °C beginning from the time of CPR initiation. Data are presented as mean ± SEM. Results The time required to reach a brain temperature of 35°C was decreased with SNPeCPR vs. Control or SNPeCPR+EPI (24 ± 6 min, 63 ± 8 min, and 50 ± 9 min, respectively, p = 0.005). Carotid blood flow was higher during CPR in the SNPeCPR group (83 ± 15 ml/min versus 26 ± 7 and 35 ± 5 in the Control and SNPeCPR+EPI group, respectively, p=0.001). Conclusion This study demonstrates that SNPeCPR facilitates intra-CPR hypothermia. The addition of epinephrine to SNPeCPR during CPR reduced its improvement in heat exchange. PMID:25525755

  20. Transfontanellar Duplex Brain Ultrasonography Resistive Indices as a Prognostic Tool in Neonatal Hypoxic-Ischemic Encephalopathy Before and After Treatment with Therapeutic Hypothermia

    PubMed Central

    Gerner, Gwendolyn J; Burton, V Joanna; Poretti, Andrea; Bosemani, Thangamadhan; Cristofalo, Elizabeth; Tekes, Aylin; Seyfert, Donna; Parkinson, Charlamaine; Leppert, Mary; Allen, Marilee; Huisman, Thierry A G M; Northington, Frances J; Johnston, Michael V

    2015-01-01

    OBJECTIVE Prior to therapeutic hypothermia (i.e., cooling), transfontanellar duplex brain sonography resistive indices (RI) were studied as bedside non-invasive measures of cerebral hemodynamics in neonates who suffered from hypoxic-ischemic encephalopathy (HIE). We compared pre- and post-cooling RI values and examined the relationships between RI values and specific long-term neurodevelopmental outcomes. STUDY DESIGN Transfontanellar duplex brain sonography, including RI, were obtained for 28 neonates prior to brain cooling and for 20 neonates following brain cooling. All RI values were sampled in the anterior cerebral artery at the beginning of each ultrasound study. Neurodevelopmental assessment was conducted between ages 20-32 months with the Mullen Scale of Early Learning. The relationships between pre- and post-cooling RI and cognitive and motor outcomes were studied. RESULT Neonates with RI values <0.60 prior to and following cooling were more likely to die or have severe neurodevelopmental disability by ages 20-32 months than those with RI >0.60. Lower RI values were associated with specific neurodevelopmental deficits in motor skill attainment. CONCLUSION Pre- and post-cooling transfontanellar duplex brain sonography RI values may be a useful prognostic tool, in conjunction with other clinical information, for neonates diagnosed with HIE. The results of this study suggest that further study of the prognostic value of RI values for short- and long-term outcomes is warranted. PMID:26609871

  1. Induced hypothermia in neurocatastrophes: feeling the chill.

    PubMed

    Wijdicks, Eelco F M

    2004-01-01

    Reducing core temperature to protect the injured brain has become a new therapeutic measure. The scientific underpinnings based on animal experiments seem sound. Evidence of the therapy's effect in human trials is insufficient or even possibly absent, but the techniques to produce moderate hypothermia are available, without apparent significant complications, and are relatively easy to use for neurointensivists. This review summarizes the mechanisms of neuroprotection due to hypothermia and its application in clinical practice. PMID:16397446

  2. A survey-based study on the protocols for therapeutic hypothermia in cardiac arrest patients in Korea: focusing on the differences between level 1 and 2 centers

    PubMed Central

    Oh, Tae Gwan; Cha, Won Chul; Jo, Ik Joon; Kang, Mun Ju; Lee, Dong Woo

    2015-01-01

    Objective We aimed to summarize the therapeutic hypothermia (TH) protocols used in emergency departments (EDs) in Korea and to investigate the differences between level 1 and 2 centers. Methods The chief residents from 56 EDs were given a structured survey containing questions on the indications for TH, methods for TH induction, maintaining, and finalizing TH treatments. The participants were divided into 2 groups based on their work place (level 1 vs. level 2 centers). Results We received 36 responses to the survey. The majority of the participants (94.4%) reported that they routinely used TH. An average of 5.9 (standard deviation, 3.4) and 3.3 (standard deviation, 2.9) TH procedures were performed monthly in level 1 and 2 centers, respectively (P=0.01). The majority of level 1 and 2 centers (80.0% and 73.1%, respectively) had written TH protocols. Rectal (50.0%) and esophageal probes (38.9%) were most commonly used to monitor the patients’ body temperatures. Midazolam (80.6%) and remifentanyl (47.2%) were the most commonly used sedatives. For TH induction, external cooling devices (77.8%) and cold saline infusion (66.1%) were predominant. Between level 1 and 2 centers, only the number of TH, the usage of remifentanyl, and application of external cooling device showed significant differences (P<0.05). Conclusion Our study summarizes the TH protocols used in 36 EDs. The majority of study participants performed TH using a written protocol. We observed small number of differences in TH induction and maintenance methods between level 1 and 2 centers. PMID:27752600

  3. Accidental hypothermia.

    PubMed

    Paton, B C

    1983-01-01

    Knowledge of the effects of hypothermia has increased greatly over the past 25 yr. Thousands of patients have been cooled intentionally in the operating room, and hundreds of thousands of living hearts have been temporarily stopped by cold cardioplegia and restarted without difficulty or apparent ill-effect. Yet in spite of the acquisition of this vast body of clinical experience an aura of mystery stills surrounds the patient who becomes hypothermic accidentally. The best treatment in any particular case is not always clear, and published accounts do not always give the impression that the hypothermic patient is treated with the same rational approach with which other sick and comatose patients are treated. In summarizing, therefore, conclusions that might be reached from reviewing past experience several important points emerge. The severely hypothermic patient should be treated in an intensive care unit where appropriate monitoring of temperature, cardiovascular function and respiratory function are available, and where full respiratory support including assisted ventilation can be given. The final outcome depends upon the etiology. The young healthy victim of exposure has a good chance of surviving. The patient poisoned by alcohol or barbiturates has a good chance of surviving provided the level of intoxication is not itself lethal. The elderly without severe underlying disease have a good chance of surviving. The patient with severe underlying disease of the endocrine, cardiovascular or neurologic system probably has, at best, a 50% chance of surviving and, at worst, a chance of only 10-20%, depending upon the associated disease. There is no statistical evidence that any one method of rewarming is significantly better than any other. But there is anecdotal evidence that in the absence of full monitoring and support systems slow rewarming is safer than over-energetic external rewarming. Internal rewarming, peritoneal dialysis, hemodialysis, inhalation of warmed

  4. [Obesity in prehospital emergency care].

    PubMed

    Kruska, Patricia; Kappus, Stefan; Kerner, Thoralf

    2012-09-01

    The prevalence of obesity has increased steadily in recent years. Obese people often suffer from diseases which acute decompensation requires a prompt prehospital therapy. The Emergency Medical Service will be confronted with difficulties in clinical diagnostic, therapy and especially with a delayed management of rescue and transport. It is most important to avoid prehospital depreciation in quality and time management. This article reviews the specific requirements of prehospital care of obese persons and discusses possible solutions to optimize the prehospital therapy. PMID:22968983

  5. Therapeutic hypothermia for the treatment of acute myocardial infarction-combined analysis of the RAPID MI-ICE and the CHILL-MI trials.

    PubMed

    Erlinge, David; Götberg, Matthias; Noc, Marko; Lang, Irene; Holzer, Michael; Clemmensen, Peter; Jensen, Ulf; Metzler, Bernhard; James, Stefan; Bøtker, Hans Erik; Omerovic, Elmir; Koul, Sasha; Engblom, Henrik; Carlsson, Marcus; Arheden, Håkan; Östlund, Ollie; Wallentin, Lars; Klos, Bradley; Harnek, Jan; Olivecrona, Göran K

    2015-06-01

    In the randomized rapid intravascular cooling in myocardial infarction as adjunctive to percutaneous coronary intervention (RAPID MI-ICE) and rapid endovascular catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction CHILL-MI studies, hypothermia was rapidly induced in conscious patients with ST-elevation myocardial infarction (STEMI) by a combination of cold saline and endovascular cooling. Twenty patients in RAPID MI-ICE and 120 in CHILL-MI with large STEMIs, scheduled for primary percutaneous coronary intervention (PCI) within <6 hours after symptom onset were randomized to hypothermia induced by rapid infusion of 600-2000 mL cold saline combined with endovascular cooling or standard of care. Hypothermia was initiated before PCI and continued for 1-3 hours after reperfusion aiming at a target temperature of 33°C. The primary endpoint was myocardial infarct size (IS) as a percentage of myocardium at risk (IS/MaR) assessed by cardiac magnetic resonance imaging at 4±2 days. Patients randomized to hypothermia treatment achieved a mean core body temperature of 34.7°C before reperfusion. Although significance was not achieved in CHILL-MI, in the pooled analysis IS/MaR was reduced in the hypothermia group, relative reduction (RR) 15% (40.5, 28.0-57.6 vs. 46.6, 36.8-63.8, p=0.046, median, interquartile range [IQR]). IS/MaR was predominantly reduced in early anterior STEMI (0-4h) in the hypothermia group, RR=31% (40.5, 28.8-51.9 vs. 59.0, 45.0-67.8, p=0.01, median, IQR). There was no mortality in either group. The incidence of heart failure was reduced in the hypothermia group (2 vs. 11, p=0.009). Patients with large MaR (>30% of the left ventricle) exhibited significantly reduced IS/MaR in the hypothermia group (40.5, 27.0-57.6 vs. 55.1, 41.1-64.4, median, IQR; hypothermia n=42 vs. control n=37, p=0.03), while patients with MaR<30% did not show effect of hypothermia (35

  6. Therapeutic hypothermia for the treatment of acute myocardial infarction-combined analysis of the RAPID MI-ICE and the CHILL-MI trials.

    PubMed

    Erlinge, David; Götberg, Matthias; Noc, Marko; Lang, Irene; Holzer, Michael; Clemmensen, Peter; Jensen, Ulf; Metzler, Bernhard; James, Stefan; Bøtker, Hans Erik; Omerovic, Elmir; Koul, Sasha; Engblom, Henrik; Carlsson, Marcus; Arheden, Håkan; Östlund, Ollie; Wallentin, Lars; Klos, Bradley; Harnek, Jan; Olivecrona, Göran K

    2015-06-01

    In the randomized rapid intravascular cooling in myocardial infarction as adjunctive to percutaneous coronary intervention (RAPID MI-ICE) and rapid endovascular catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction CHILL-MI studies, hypothermia was rapidly induced in conscious patients with ST-elevation myocardial infarction (STEMI) by a combination of cold saline and endovascular cooling. Twenty patients in RAPID MI-ICE and 120 in CHILL-MI with large STEMIs, scheduled for primary percutaneous coronary intervention (PCI) within <6 hours after symptom onset were randomized to hypothermia induced by rapid infusion of 600-2000 mL cold saline combined with endovascular cooling or standard of care. Hypothermia was initiated before PCI and continued for 1-3 hours after reperfusion aiming at a target temperature of 33°C. The primary endpoint was myocardial infarct size (IS) as a percentage of myocardium at risk (IS/MaR) assessed by cardiac magnetic resonance imaging at 4±2 days. Patients randomized to hypothermia treatment achieved a mean core body temperature of 34.7°C before reperfusion. Although significance was not achieved in CHILL-MI, in the pooled analysis IS/MaR was reduced in the hypothermia group, relative reduction (RR) 15% (40.5, 28.0-57.6 vs. 46.6, 36.8-63.8, p=0.046, median, interquartile range [IQR]). IS/MaR was predominantly reduced in early anterior STEMI (0-4h) in the hypothermia group, RR=31% (40.5, 28.8-51.9 vs. 59.0, 45.0-67.8, p=0.01, median, IQR). There was no mortality in either group. The incidence of heart failure was reduced in the hypothermia group (2 vs. 11, p=0.009). Patients with large MaR (>30% of the left ventricle) exhibited significantly reduced IS/MaR in the hypothermia group (40.5, 27.0-57.6 vs. 55.1, 41.1-64.4, median, IQR; hypothermia n=42 vs. control n=37, p=0.03), while patients with MaR<30% did not show effect of hypothermia (35

  7. Induced Hypothermia Does Not Harm Hemodynamics after Polytrauma: A Porcine Model

    PubMed Central

    Weuster, Matthias; Mommsen, Philipp; Pfeifer, Roman; Mohr, Juliane; Ruchholtz, Steffen; Flohé, Sascha; Fröhlich, Matthias; Keibl, Claudia; Seekamp, Andreas; van Griensven, Martijn; Witte, Ingo

    2015-01-01

    Background. The deterioration of hemodynamics instantly endangers the patients' life after polytrauma. As accidental hypothermia frequently occurs in polytrauma, therapeutic hypothermia still displays an ambivalent role as the impact on the cardiopulmonary function is not yet fully understood. Methods. We have previously established a porcine polytrauma model including blunt chest trauma, penetrating abdominal trauma, and hemorrhagic shock. Therapeutic hypothermia (34°C) was induced for 3 hours. We documented cardiovascular parameters and basic respiratory parameters. Pigs were euthanized after 15.5 hours. Results. Our polytrauma porcine model displayed sufficient trauma impact. Resuscitation showed adequate restoration of hemodynamics. Induced hypothermia had neither harmful nor major positive effects on the animals' hemodynamics. Though heart rate significantly decreased and mixed venous oxygen saturation significantly increased during therapeutic hypothermia. Mean arterial blood pressure, central venous pressure, pulmonary arterial pressure, and wedge pressure showed no significant differences comparing normothermic trauma and hypothermic trauma pigs during hypothermia. Conclusions. Induced hypothermia after polytrauma is feasible. No major harmful effects on hemodynamics were observed. Therapeutic hypothermia revealed hints for tissue protective impact. But the chosen length for therapeutic hypothermia was too short. Nevertheless, therapeutic hypothermia might be a useful tool for intensive care after polytrauma. Future studies should extend therapeutic hypothermia. PMID:26170533

  8. Predictive value of the amplitude integrated EEG in infants with hypoxic ischaemic encephalopathy: data from a randomised trial of therapeutic hypothermia.

    PubMed

    Azzopardi, Denis

    2014-01-01

    The amplitude integrated EEG (aEEG) is reputed to be one of the best predictors of neurological outcome following hypoxic ischaemic encephalopathy in term newborns and was used to select infants into trials of neuroprotection with hypothermia, but its predictive value and the effect of moderate hypothermia on the aEEG have not previously been examined in a randomised study. The positive predictive value (PPV) of the aEEG recorded within 6 h of birth for death or disability at 18 months of age was determined in 314 infants born after 35 weeks gestation who were randomised to receive standard care with or without cooling for 72 h. The aEEG was classified according to voltage and by pattern. The PPV of a severely abnormal aEEG assessed by the voltage and pattern methods was 0.63 and 0.59 respectively in non-cooled infants and 0.55 and 0.51 in cooled infants (p>0.05). Although the differences in PPV between cooled and non-cooled groups were not significant, they are consistent with observational studies showing a lower PPV in infants treated with hypothermia, probably due to a neuroprotective effect of cooling.

  9. Hypothermia in Traumatic Brain Injury.

    PubMed

    Ahmed, Aminul I; Bullock, M Ross; Dietrich, W Dalton

    2016-10-01

    For over 50 years, clinicians have used hypothermia to manage traumatic brain injury (TBI). In the last two decades numerous trials have assessed whether hypothermia is of benefit in patients. Mild to moderate hypothermia reduces the intracranial pressure (ICP). Randomized control trials for short-term hypothermia indicate no benefit in outcome after severe TBI, whereas longer-term hypothermia could be of benefit by reducing ICP. This article summarises current evidence and gives recommendations based upon the conclusions. PMID:27637398

  10. Hypothermia After Cardiac Arrest as a Novel Approach to Increase Survival in Cardiopulmonary Cerebral Resuscitation: A Review

    PubMed Central

    Soleimanpour, Hassan; Rahmani, Farzad; Safari, Saeid; EJ Golzari, Samad

    2014-01-01

    Context: The aim of this review study was to evaluate therapeutic mild hypothermia, its complications and various methods for induced mild hypothermia in patients following resuscitation after out-of-hospital cardiac arrest. Evidence Acquisition: Studies conducted on post-cardiac arrest cares, history of induced hypothermia, and therapeutic hypothermia for patients with cardiac arrest were included in this study. We used the valid databases (PubMed and Cochrane library) to collect relevant articles. Results: According to the studies reviewed, induction of mild hypothermia in patients after cardiopulmonary resuscitation would lead to increased survival and better neurological outcome; however, studies on the complications of hypothermia or different methods of inducing hypothermia were limited and needed to be studied further. Conclusions: This study provides strategic issues concerning the induction of mild hypothermia, its complications, and different ways of performing it on patients; using this method helps to increase patients’ neurological survival rate. PMID:25237582

  11. Prehospital Trauma Care in Singapore.

    PubMed

    Ho, Andrew Fu Wah; Chew, David; Wong, Ting Hway; Ng, Yih Yng; Pek, Pin Pin; Lim, Swee Han; Anantharaman, Venkataraman; Hock Ong, Marcus Eng

    2015-01-01

    Prehospital emergency care in Singapore has taken shape over almost a century. What began as a hospital-based ambulance service intended to ferry medical cases was later complemented by an ambulance service under the Singapore Fire Brigade to transport trauma cases. The two ambulance services would later combine and come under the Singapore Civil Defence Force. The development of prehospital care systems in island city-state Singapore faces unique challenges as a result of its land area and population density. This article defines aspects of prehospital trauma care in Singapore. It outlines key historical milestones and current initiatives in service, training, and research. It makes propositions for the future direction of trauma care in Singapore. The progress Singapore has made given her circumstances may serve as lessons for the future development of prehospital trauma systems in similar environments. Key words: Singapore; trauma; prehospital emergency care; emergency medical services.

  12. Advances in prehospital trauma care

    PubMed Central

    Williamson, Kelvin; Ramesh, Ramaiah; Grabinsky, Andreas

    2011-01-01

    Prehospital trauma care developed over the last decades parallel in many countries. Most of the prehospital emergency medical systems relied on input or experiences from military medicine and were often modeled after the existing military procedures. Some systems were initially developed with the trauma patient in mind, while other systems were tailored for medical, especially cardiovascular, emergencies. The key components to successful prehospital trauma care are the well-known ABCs of trauma care: Airway, Breathing, Circulation. Establishing and securing the airway, ventilation, fluid resuscitation, and in addition, the quick transport to the best-suited trauma center represent the pillars of trauma care in the field. While ABC in trauma care has neither been challenged nor changed, new techniques, tools and procedures have been developed to make it easier for the prehospital provider to achieve these goals in the prehospital setting and thus improve the outcome of trauma patients. PMID:22096773

  13. Spontaneous periodic hypothermia.

    PubMed

    Kloos, R T

    1995-09-01

    Spontaneous periodic hypothermia is a rare syndrome of recurrent, centrally mediated hypothermia without an identifiable systemic cause or brain lesion. Most patients defend a temporarily lowered temperature "set point" during episodes of hypothermia, despite manifesting many well-known systemic consequences of core temperature hypothermia. No case of death directly attributable to an episode of spontaneous periodic hypothermia has been reported, although many of the serious systemic effects of hypothermia have been documented in these cases, so it is not unlikely that death may occur. The syndrome's cause, and that of Shapiro syndrome, remains unknown. Pharmacologic trials to date have been only modestly successful. Anticonvulsant agents, clonidine, and cyproheptadine appear the most likely to succeed, with cyproheptadine being a reasonable first choice. Given that the term "spontaneous periodic hypothermia" describes a syndrome, and not a pathophysiologic mechanism, it is likely to encompass a common eventuality, arrived at via several different pathways. One can postulate mechanisms such as structural abnormalities, trauma, infection, irritation, and degeneration involving strategic locations which create a focus for epileptic or other periodic dysfunction whose scope involves the centers for thermoregulation. The existence of 2 distinct, oppositional thermoregulatory centers would allow for speculation of similar mechanisms accounting for cases of both periodic hypo- and hyperthermia (61). Postmortem data regarding the hypothalamic and surrounding areas from future cases of Shapiro syndrome and spontaneous periodic hypothermia would be of great interest. Further, more sensitive in vivo testing methods are clearly needed. The role of PET or single photon emission computed tomography (SPECT) with technetium 99m-labeled hexamethylpropylene amine oxime (Tc 99m HMPAO) performed acutely during an episode remains to be characterized (64, 103, 105). The term

  14. Management of neonatal morbidities during hypothermia treatment.

    PubMed

    Sarkar, Subrata; Barks, John

    2015-04-01

    Although the primary goal of therapeutic hypothermia is to improve the neurodevelopmental outcome in asphyxiated infants, optimal management of the full range of multi-organ system complications typically presented by such infants during cooling treatment is necessary for improvement of the overall outcome. For this reason, adequate knowledge of how cooling affects all organ systems of asphyxiated infants with multi-organ hypoxic-ischemic injury is essential. Adequate diagnostic resources, readily available subspecialty consultant services and trained multidisciplinary staff to monitor and manage multi-organ system complications in asphyxiated infants during therapeutic cooling must be ensured during implementation of a cooling program. As therapeutic hypothermia is being used more widely, centers should consider participation in national or international benchmarking of outcomes and short-term adverse events during cooling to facilitate continuous quality improvement efforts.

  15. Management of neonatal morbidities during hypothermia treatment.

    PubMed

    Sarkar, Subrata; Barks, John

    2015-04-01

    Although the primary goal of therapeutic hypothermia is to improve the neurodevelopmental outcome in asphyxiated infants, optimal management of the full range of multi-organ system complications typically presented by such infants during cooling treatment is necessary for improvement of the overall outcome. For this reason, adequate knowledge of how cooling affects all organ systems of asphyxiated infants with multi-organ hypoxic-ischemic injury is essential. Adequate diagnostic resources, readily available subspecialty consultant services and trained multidisciplinary staff to monitor and manage multi-organ system complications in asphyxiated infants during therapeutic cooling must be ensured during implementation of a cooling program. As therapeutic hypothermia is being used more widely, centers should consider participation in national or international benchmarking of outcomes and short-term adverse events during cooling to facilitate continuous quality improvement efforts. PMID:25701292

  16. Determinants of Effective Cooling during Endovascular Hypothermia

    PubMed Central

    Lyden, Patrick; Ernstrom, Karin; Cruz-Flores, Salvador; Gomes, Joao; Grotta, James; Mullin, Anthony; Rapp, Karen; Raman, Rema; Wijman, Christine; Hemmen, Thomas

    2012-01-01

    Therapeutic hypothermia is a promising neuroprotective therapy with multiple mechanisms of action. We demonstrated the feasibility of thrombolysis combined with endovascular hypothermia, but not all patients achieved effective cooling. We sought to identify the factors that determined effective cooling. Methods In 26 patients who underwent endovascular hypothermia we computed 4 measures of effective cooling: time to reach target; Area-Under-the-Curve (AUC) 34 ratio; AUC-34; and AUC-35. Using multivariate regression, we examined the effects of age, weight, starting temperature, body mass index, body surface area (BSA) , gender, shivering, and total meperidine dose on the 4 outcome measures. Results In univariate analyses, all 4 outcome measures were significantly influenced by BSA (p<0.01 in all univariate analyses). Time to reach target temperature was quicker in older patients (p<0.01). Shivering and meperidine dose were highly intercorrelated (r=0.6, p<0.01) and both marginally influenced all 4 outcome measures. In multivariate analysis, AUC ratio and time to reach target temperature were significantly influenced by BSA (p<0.01) and meperidine (p<0.05); AUC-34 was influenced only by BSA (p<0.01). The AUC- 35 was influenced by BSA (p<0.01), shivering, and total meperidine dose (p<0.05). Conclusions The most important determinant of effective cooling during endovascular hypothermia is BSA; larger patients are more difficult to cool and maintain in therapeutic range. Older patients cool more quickly. Shivering was well controlled by the combination of meperidine, buspirone, and surface counter-warming and only minimally influenced cooling effectiveness. Future trials of therapeutic hypothermia may include added measures to cool larger patients more effectively. PMID:22466971

  17. Pre-hospital emergency medicine.

    PubMed

    Wilson, Mark H; Habig, Karel; Wright, Christopher; Hughes, Amy; Davies, Gareth; Imray, Chirstopher H E

    2015-12-19

    Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes. The transfer of skills and procedures from hospital care to pre-hospital medicine enables early advanced care across a range of disciplines. The variety of possible pathologies, challenges of environmental factors, and hazardous situations requires management that is tailored to the patient's clinical need and setting. Pre-hospital clinicians should be generalists with a broad understanding of medical, surgical, and trauma pathologies, who will often work from locally developed standard operating procedures, but who are able to revert to core principles. Pre-hospital emergency medicine consists of not only clinical care, but also logistics, rescue competencies, and scene management skills (especially in major incidents, which have their own set of management principles). Traditionally, research into the hyper-acute phase (the first hour) of disease has been difficult, largely because physicians are rarely present and issues of consent, transport expediency, and resourcing of research. However, the pre-hospital phase is acknowledged as a crucial period, when irreversible pathology and secondary injury to neuronal and cardiac tissue can be prevented. The development of pre-hospital emergency medicine into a sub-specialty in its own right should bring focus to this period of care. PMID:26738719

  18. When, where and how to initiate hypothermia after adult cardiac arrest.

    PubMed

    Taccone, F S; Donadello, K; Beumier, M; Scolletta, S

    2011-09-01

    Therapeutich hypothermia (TH) has been shown to improve neurological outcome and survival after witnessed cardiac arrest (CA) that is due to ventricular fibrillation. Although TH is widely used following witnessed CA as well as all forms of initial rhythm, the mortality rate after CA remains unacceptably high, and additional study is needed to understand when and how to implement hypothermia in the post-resuscitation phase. Experimental studies have emphasized the importance of initiating cooling soon after the return of spontaneous circulation (ROSC) or even during cardiopulmonary resuscitation (CPR). Clinical studies have shown that pre-hospital induction of hypothermia is feasible and has no major adverse events-even when used intra-arrest-and may provide some additional benefits compared to delayed in-hospital cooling. Thus, hypothermia use should not be limited to the Intensive Care Unit but can be initiated in the field/ambulance or in the Emergency Department, then continued after hospital admission- even during specific procedures such as coronary angiography-as part of the global management of CA patients. Various methods (both non-invasive and invasive) are available to achieve and maintain the target temperature; however, only some of these methods-which include cold fluids, ice packs, iced pads and helmet and trans-nasal cooling- are easily deployed in the pre-hospital setting. PMID:21878875

  19. Endogenous hypothermic response to hypoxia reduces brain injury: Implications for modeling hypoxic-ischemic encephalopathy and therapeutic hypothermia in neonatal mice.

    PubMed

    Reinboth, Barbara S; Köster, Christian; Abberger, Hanna; Prager, Sebastian; Bendix, Ivo; Felderhoff-Müser, Ursula; Herz, Josephine

    2016-09-01

    Hypothermia treatment (HT) is the only formally endorsed treatment recommended for hypoxic-ischemic encephalopathy (HIE). However, its success in protecting against brain injury is limited with a number to treat of 7-8. The identification of the target mechanisms of HIE in combination with HT will help to explain ineffective therapy outcomes but also requires stable experimental models in order to establish further neuroprotective therapies. Despite clinical and experimental indications for an endogenous thermoregulatory response to HIE, the potential effects on HIE-induced brain injury have largely been neglected in pre-clinical studies. In the present study we analyzed gray and white matter injury and neurobehavioral outcome in neonatal mice considering the endogenous thermoregulatory response during HIE combined with HT. HIE was induced in postnatal day (PND) 9 C57BL/6 mice through occlusion of the right common carotid artery followed by one hour of hypoxia. Hypoxia was performed at 8% or 10% oxygen (O2) at two different temperatures based on the nesting body core temperature. Using the model which mimics the clinical situation most closely, i.e. through maintenance of the nesting temperature during hypoxia we compared two mild HT protocols (rectal temperature difference 3°C for 4h), initiated either immediately after HIE or with delay of 2h. Injury was determined by histology, immunohistochemistry and western blot analyses at PND 16 and PND 51. Functional outcome was evaluated by Rota Rod, Elevated Plus Maze, Open Field and Novel Object Recognition testing at PND 30-PND 36 and PND 44-PND 50. We show that HIE modeling in neonatal mice is associated with a significant endogenous drop in body core temperature by 2°C resulting in profound neuroprotection, expressed by reduced neuropathological injury scores, reduced loss of neurons, axonal structures, myelin and decreased astrogliosis. Immediately applied post-hypoxic HT revealed slight advantages over a delayed

  20. Endogenous hypothermic response to hypoxia reduces brain injury: Implications for modeling hypoxic-ischemic encephalopathy and therapeutic hypothermia in neonatal mice.

    PubMed

    Reinboth, Barbara S; Köster, Christian; Abberger, Hanna; Prager, Sebastian; Bendix, Ivo; Felderhoff-Müser, Ursula; Herz, Josephine

    2016-09-01

    Hypothermia treatment (HT) is the only formally endorsed treatment recommended for hypoxic-ischemic encephalopathy (HIE). However, its success in protecting against brain injury is limited with a number to treat of 7-8. The identification of the target mechanisms of HIE in combination with HT will help to explain ineffective therapy outcomes but also requires stable experimental models in order to establish further neuroprotective therapies. Despite clinical and experimental indications for an endogenous thermoregulatory response to HIE, the potential effects on HIE-induced brain injury have largely been neglected in pre-clinical studies. In the present study we analyzed gray and white matter injury and neurobehavioral outcome in neonatal mice considering the endogenous thermoregulatory response during HIE combined with HT. HIE was induced in postnatal day (PND) 9 C57BL/6 mice through occlusion of the right common carotid artery followed by one hour of hypoxia. Hypoxia was performed at 8% or 10% oxygen (O2) at two different temperatures based on the nesting body core temperature. Using the model which mimics the clinical situation most closely, i.e. through maintenance of the nesting temperature during hypoxia we compared two mild HT protocols (rectal temperature difference 3°C for 4h), initiated either immediately after HIE or with delay of 2h. Injury was determined by histology, immunohistochemistry and western blot analyses at PND 16 and PND 51. Functional outcome was evaluated by Rota Rod, Elevated Plus Maze, Open Field and Novel Object Recognition testing at PND 30-PND 36 and PND 44-PND 50. We show that HIE modeling in neonatal mice is associated with a significant endogenous drop in body core temperature by 2°C resulting in profound neuroprotection, expressed by reduced neuropathological injury scores, reduced loss of neurons, axonal structures, myelin and decreased astrogliosis. Immediately applied post-hypoxic HT revealed slight advantages over a delayed

  1. Renal Insufficiency and Early Bystander CPR Predict In-Hospital Outcomes in Cardiac Arrest Patients Undergoing Mild Therapeutic Hypothermia and Cardiac Catheterization: Return of Spontaneous Circulation, Cooling, and Catheterization Registry (ROSCCC Registry)

    PubMed Central

    Chelvanathan, Anjala; Allen, David; Bews, Hilary; Ducas, John; Minhas, Kunal; Ravandi, Amir; Jassal, Davinder S.; Hussain, Farrukh

    2016-01-01

    Objective. Out of hospital cardiac arrest (OHCA) patients are a critically ill patient population with high mortality. Combining mild therapeutic hypothermia (MTH) with early coronary intervention may improve outcomes in this population. The aim of this study was to evaluate predictors of mortality in OHCA patients undergoing MTH with and without cardiac catheterization. Design. A retrospective cohort of OHCA patients who underwent MTH with catheterization (MTH + C) and without catheterization (MTH + NC) between 2006 and 2011 was analyzed at a single tertiary care centre. Predictors of in-hospital mortality and neurologic outcome were determined. Results. The study population included 176 patients who underwent MTH for OHCA. A total of 66 patients underwent cardiac catheterization (MTH + C) and 110 patients did not undergo cardiac catheterization (MTH + NC). Immediate bystander CPR occurred in approximately half of the total population. In the MTH + C and MTH + NC groups, the in-hospital mortality was 48% and 78%, respectively. The only independent predictor of in-hospital mortality for patients with MTH + C, after multivariate analysis, was baseline renal insufficiency (OR = 8.2, 95% CI 1.8–47.1, and p = 0.009). Conclusion. Despite early cardiac catheterization, renal insufficiency and the absence of immediate CPR are potent predictors of death and poor neurologic outcome in patients with OHCA. PMID:26885436

  2. Hypothermia following antipsychotic drug use

    PubMed Central

    Wegewijs, Michelle A.; Loonen, Anton J. M.; Beers, Erna

    2007-01-01

    Objective Hypothermia is an adverse drug reaction (ADR) of antipsychotic drug (APD) use. Risk factors for hypothermia in ADP users are unknown. We studied which risk factors for hypothermia can be identified based on case reports. Method Case reports of hypothermia in APD-users found in PUBMED or EMBASE were searched for risk factors. The WHO international database for Adverse Drug Reactions was searched for reports of hypothermia and APD use. Results The literature search resulted in 32 articles containing 43 case reports. In the WHO database, 480 reports were registered of patients developing hypothermia during the use of APDs which almost equals the number of reports for hyperthermia associated with APD use (n = 524). Hypothermia risk seems to be increased in the first days following start or dose increase of APs. APs with strong 5-HT2 antagonism seem to be more involved in hypothermia; 55% of hypothermia reports are for atypical antipsychotics. Schizophrenia was the most prevalent diagnosis in the case reports. Conclusion Especially in admitted patients who are not able to control their own environment or physical status, frequent measurements of body temperature (with a thermometer that can measure low body temperatures) must be performed in order to detect developing hypothermia. PMID:17401555

  3. Agenesis of the corpus callosum associated with paroxysmal hypothermia: Shapiro's syndrome.

    PubMed

    Segeren, C M; Polderman, K H; Lips, P

    1997-01-01

    Spontaneous recurrent hypothermia and hyperhidrosis associated with agenesis of the corpus callosum was first described by Shapiro and Plum in 1967. Since then, several cases with similar symptoms (now known as Shapiro's syndrome or spontaneous periodic hypothermia) have been described. We report another case of this syndrome in a 21-year-old-man, and discuss possible pathogenetic mechanisms and therapeutic approaches. PMID:9038041

  4. Postmortem pulmonary CT in hypothermia.

    PubMed

    Schweitzer, Wolf; Thali, Michael; Giugni, Giannina; Winklhofer, Sebastian

    2014-12-01

    Fatal hypothermia has been associated with pulmonary edema. With postmortem full body computed tomography scanning (PMCT), the lungs can also be examined for CT attenuation. In fatal hypothermia cases low CT attenuation appeared to prevail in the lungs. We compared 14 cases of fatal hypothermia with an age-sex matched control group. Additionally, 4 cases of carbon monoxide (CO) poisoning were examined. Furthermore, 10 test cases were examined to test predictability based on PMCT. Two readers measured CT attenuation on four different axial slices across the lungs (blinded to case group and other reader's results). Hypothermia was associated with statistically significantly lower lung PMCT attenuation and lower lung weights than controls, and there was a dose-effect relationship at an environmental temperature cutoff of 2 °C. CO poisoning yielded low pulmonary attenuation but higher lung weights. General model based prediction yielded a 94% probability for fatal hypothermia deaths and a 21% probability for non-hypothermia deaths in the test group. Increased breathing rate is known to accompany both CO poisoning and hypothermia, so this could partly explain the low PMCT lung attenuation due to an oxygen dissociation curve left shift. A more marked distension in fatal hypothermia, compared to CO poisoning, indicates that further, possibly different mechanisms, are involved in these cases. Increased dead space and increased stiffness to deflation (but not inflation) appear to be effects of inhaling cold air (but not CO) that may explain the difference in low PMCT attenuation seen in hypothermia cases. PMID:25326676

  5. Hypothermia and the trauma patient

    PubMed Central

    Kirkpatrick, Andrew W.; Chun, Rosaleen; Brown, Ross; Simons, Richard K.

    Hypothermia has profound effects on every system in the body, causing an overall slowing of enzymatic reactions and reduced metabolic requirements. Hypothermic, acutely injured patients with multisystem trauma have adverse outcomes when compared with normothermic control patients. Trauma patients are inherently predisposed to hypothermia from a variety of intrinsic and iatrogenic causes. Coagulation and cardiac sequelae are the most pertinent physiological concerns. Hypothermia and coagulopathy often mandate a simplified approach to complex surgical problems. A modification of traditional classification systems of hypothermia, applicable to trauma patients is suggested. There are few controlled investigations, but clinical opinion strongly supports the active prevention of hypothermia in the acutely traumatized patient. Preventive measures are simple and inexpensive, but the active reversal of hypothermia is much more complicated, often invasive and controversial. The ideal method of rewarming is unclear but must be individualized to the patient and is institution specific. An algorithm reflecting newer approaches to traumatic injury and technical advances in equipment and techniques is suggested. Conversely, hypothermia has selected clinical benefits when appropriately used in cases of trauma. Severe hypothermia has allowed remarkable survivals in the course of accidental circulatory arrest. The selective application of mild hypothermia in severe traumatic brain injury is an area with promise. Deliberate circulatory arrest with hypothermic cerebral protection has also been used for seemingly unrepairable injuries and is the focus of ongoing research. PMID:10526517

  6. Postmortem pulmonary CT in hypothermia.

    PubMed

    Schweitzer, Wolf; Thali, Michael; Giugni, Giannina; Winklhofer, Sebastian

    2014-12-01

    Fatal hypothermia has been associated with pulmonary edema. With postmortem full body computed tomography scanning (PMCT), the lungs can also be examined for CT attenuation. In fatal hypothermia cases low CT attenuation appeared to prevail in the lungs. We compared 14 cases of fatal hypothermia with an age-sex matched control group. Additionally, 4 cases of carbon monoxide (CO) poisoning were examined. Furthermore, 10 test cases were examined to test predictability based on PMCT. Two readers measured CT attenuation on four different axial slices across the lungs (blinded to case group and other reader's results). Hypothermia was associated with statistically significantly lower lung PMCT attenuation and lower lung weights than controls, and there was a dose-effect relationship at an environmental temperature cutoff of 2 °C. CO poisoning yielded low pulmonary attenuation but higher lung weights. General model based prediction yielded a 94% probability for fatal hypothermia deaths and a 21% probability for non-hypothermia deaths in the test group. Increased breathing rate is known to accompany both CO poisoning and hypothermia, so this could partly explain the low PMCT lung attenuation due to an oxygen dissociation curve left shift. A more marked distension in fatal hypothermia, compared to CO poisoning, indicates that further, possibly different mechanisms, are involved in these cases. Increased dead space and increased stiffness to deflation (but not inflation) appear to be effects of inhaling cold air (but not CO) that may explain the difference in low PMCT attenuation seen in hypothermia cases.

  7. [Management of severe accidental hypothermia].

    PubMed

    Avellanas, M L; Ricart, A; Botella, J; Mengelle, F; Soteras, I; Veres, T; Vidal, M

    2012-04-01

    Accidental hypothermia is an environmental condition with basic principles of classification and resuscitation that apply to mountain, sea or urban scenarios. Along with coagulopathy and acidosis, hypothermia belongs to the lethal triad of trauma victims requiring critical care. A customized healthcare chain is involved in its management, extending from on site assistance to intensive care, cardiac surgery and/or the extracorporeal circulation protocols. A good classification of the degree of hypothermia preceding admission contributes to improve management and avoids inappropriate referrals between hospitals. The most important issue is to admit hypothermia victims in asystolia or ventricular fibrillation to those hospitals equipped with the medical technology which these special clinical scenarios require. This study attempts to establish the foundations for optimum management of accidental hypothermia from first emergency care on site to treatment in hospital including, resuscitation and rewarming with extracorporeal circulation.

  8. Seizures and hypothermia: importance of electroencephalographic monitoring and considerations for treatment.

    PubMed

    Boylan, Geraldine B; Kharoshankaya, Liudmila; Wusthoff, Courtney J

    2015-04-01

    Hypoxic-ischemic encephalopathy is a common cause of seizures in neonates. Despite the introduction of therapeutic hypothermia, seizure rates are similar to those reported in the pre-therapeutic hypothermia era. However, the seizure profile has been altered resulting in a lower overall seizure burden, shorter individual seizure durations, and seizures that are harder to detect. Electroencephalographic (EEG) monitoring is the gold standard for detecting all seizures in neonates and this is even more critical in neonates who are cooled, as they are often sedated, making seizures more difficult to detect. Several studies have shown that the majority of seizures in neonates undergoing therapeutic hypothermia remain subclinical, thus requiring EEG monitoring for diagnosis. Amplitude-integrated EEG monitoring is useful but shorter duration seizures are more likely to be missed. Evidence is emerging about the pharmacokinetic profile of routinely used antiepileptic drugs during therapeutic hypothermia and some modifications have been suggested, particularly for lidocaine use.

  9. Seizures and hypothermia: importance of electroencephalographic monitoring and considerations for treatment.

    PubMed

    Boylan, Geraldine B; Kharoshankaya, Liudmila; Wusthoff, Courtney J

    2015-04-01

    Hypoxic-ischemic encephalopathy is a common cause of seizures in neonates. Despite the introduction of therapeutic hypothermia, seizure rates are similar to those reported in the pre-therapeutic hypothermia era. However, the seizure profile has been altered resulting in a lower overall seizure burden, shorter individual seizure durations, and seizures that are harder to detect. Electroencephalographic (EEG) monitoring is the gold standard for detecting all seizures in neonates and this is even more critical in neonates who are cooled, as they are often sedated, making seizures more difficult to detect. Several studies have shown that the majority of seizures in neonates undergoing therapeutic hypothermia remain subclinical, thus requiring EEG monitoring for diagnosis. Amplitude-integrated EEG monitoring is useful but shorter duration seizures are more likely to be missed. Evidence is emerging about the pharmacokinetic profile of routinely used antiepileptic drugs during therapeutic hypothermia and some modifications have been suggested, particularly for lidocaine use. PMID:25683598

  10. Method for inducing hypothermia

    DOEpatents

    Becker, Lance B.; Hoek, Terry Vanden; Kasza, Kenneth E.

    2003-04-15

    Systems for phase-change particulate slurry cooling equipment and methods to induce hypothermia in a patient through internal and external cooling are provided. Subcutaneous, intravascular, intraperitoneal, gastrointestinal, and lung methods of cooling are carried out using saline ice slurries or other phase-change slurries compatible with human tissue. Perfluorocarbon slurries or other slurry types compatible with human tissue are used for pulmonary cooling. And traditional external cooling methods are improved by utilizing phase-change slurry materials in cooling caps and torso blankets.

  11. Method for inducing hypothermia

    DOEpatents

    Becker, Lance B.; Hoek, Terry Vanden; Kasza, Kenneth E.

    2005-11-08

    Systems for phase-change particulate slurry cooling equipment and methods to induce hypothermia in a patient through internal and external cooling are provided. Subcutaneous, intravascular, intraperitoneal, gastrointestinal, and lung methods of cooling are carried out using saline ice slurries or other phase-change slurries compatible with human tissue. Perfluorocarbon slurries or other slurry types compatible with human tissue are used for pulmonary cooling. And traditional external cooling methods are improved by utilizing phase-change slurry materials in cooling caps and torso blankets.

  12. Method for inducing hypothermia

    DOEpatents

    Becker, Lance B.; Hoek, Terry Vanden; Kasza, Kenneth E.

    2008-09-09

    Systems for phase-change particulate slurry cooling equipment and methods to induce hypothermia in a patient through internal and external cooling are provided. Subcutaneous, intravascular, intraperitoneal, gastrointestinal, and lung methods of cooling are carried out using saline ice slurries or other phase-change slurries compatible with human tissue. Perfluorocarbon slurries or other slurry types compatible with human tissue are used for pulmonary cooling. And traditional external cooling methods are improved by utilizing phase-change slurry materials in cooling caps and torso blankets.

  13. Hypothermia inhibits the propagation of acute ischemic injury by inhibiting HMGB1.

    PubMed

    Lee, Jung Ho; Yoon, Eun Jang; Seo, Jeho; Kavoussi, Adriana; Chung, Yong Eun; Chung, Sung Phil; Park, Incheol; Kim, Chul Hoon; You, Je Sung

    2016-01-01

    Acute ischemic stroke causes significant chronic disability worldwide. We designed this study to clarify the mechanism by which hypothermia helps alleviate acute ischemic stroke. In a middle cerebral artery occlusion model (4 h ischemia without reperfusion), hypothermia effectively reduces mean infarct volume. Hypothermia also prevents neurons in the infarct area from releasing high mobility group box 1 (HMGB1), the most well-studied damage-associated molecular pattern protein. By preventing its release, hypothermia also prevents the typical middle cerebral artery occlusion-induced increase in serum HMGB1. We also found that both glycyrrhizin-mediated inhibition of HMGB1 and intracerebroventricular neutralizing antibody treatments before middle cerebral artery occlusion onset diminish infarct volume. This suggests a clear neuroprotective effect of HMGB1 inhibition by hypothermia in the brain. We next used real-time polymerase chain reaction to measure the levels of pro-inflammatory cytokines in peri-infarct regions. Although middle cerebral artery occlusion increases the expression of interleukin-1β and tissue necrosis factor-α, this elevation is suppressed by both hypothermia and glycyrrhizin treatment. We show that hypothermia reduces the production of inflammatory cytokines and helps salvage peri-infarct regions from the propagation of ischemic injury via HMGB1 blockade. In addition to suggesting a potential mechanism for hypothermia's therapeutic effects, our results suggest HMGB1 modulation may lengthen the therapeutic window for stroke treatments. PMID:27544687

  14. Successful hypothermia treatment of hypoxic-ischemic encephalopathy in a neonate with epidermolysis bullosa.

    PubMed

    Karadag, Nilgun; Beken, Serdar; Dilli, Dilek; Zenciroglu, Aysegul; Okumus, Nurullah

    2014-08-01

    Despite advances in the neonatal care, hypoxic ischemic encephalopathy in late preterm and term infants remains an important cause of morbidity and mortality. There is lack of data on the application of therapeutic hypothermia in the existence of severe skin lesions. Epidermolysis bullosa is a rare group of inherited conditions which causes blisters in skin and mucosal membranes. In this report, the authors describe a successful whole-body hypothermia treatment of severe hypoxic ischemic encephalopathy in a term newborn with dystrophic epidermolysis bullosa. They observed that therapeutic hypothermia may also be given in newborns with dystrophic epidermolysis bullosa without any complications.

  15. Prevention of inadvertent perioperative hypothermia.

    PubMed

    Burger, Leona; Fitzpatrick, Jane

    All patients undergoing surgery are at risk of developing hypothermia; up to 70% develop hypothermia perioperatively. Inadvertent hypothermia is associated with complications such as impaired wound healing, increased blood loss, cardiac arrest and increased risk of wound infection. Anaesthesia increases the risk as the normal protective shivering reflex is absent. Ambient temperature also has a major effect on the patient's body temperature. Prevention of hypothermia not only reduces the incidence of complications, but patients also experience a greater level of comfort, and avoid postoperative shivering and the unpleasant sensation of feeling cold. Nurses should be aware of the risks of hypothermia so that preventative interventions can be employed to minimize the risk of hypothermia. Preoperative assessment is essential to enable identification of at-risk patients. Simple precautionary measures initiated by nurses can considerably reduce the amount of heat lost, minimize the risk of associated complications and ultimately improve patients' short- and long-term recovery. Minimizing skin exposure, providing adequate bed linen for the transfer to theatre and educating patients about the importance of keeping warm perioperatively are all extremely important. It is also worth considering using forced-air warmers preoperatively as research suggests that initiating active warming preoperatively may be successful in preventing hypothermia during the perioperative period. PMID:19966730

  16. Congenital diaphragmatic hernia repair during whole body hypothermia for neonatal hypoxic ischemic encephalopathy.

    PubMed

    Buratti, S; Lampugnani, E; Tuo, P; Moscatelli, A

    2012-12-01

    Major malformations, surgery and persistent pulmonary hypertension (PHT) have been considered contraindications to therapeutic hypothermia (TH) in newborns with hypoxic-ischemic encephalopathy (HIE). We report two patients with undiagnosed congenital diaphragmatic hernia (CDH) who developed HIE after birth. Diagnosis of moderate HIE was formulated based on clinical, laboratory and electroencephalographic criteria. The patients were treated with whole body hypothermia (33.5 °C) for 72 h. During hypothermia the patients underwent surgical repair with regular perioperative course. Ventilatory support with high-frequency oscillatory ventilation, oxygen requirements and inotropic support remained stable during hypothermia. Serial echocardiographic evaluations did not demonstrate any change in pulmonary pressure values. In our experience TH did not increase the risk of hemodynamic instability, PHT or bleeding. Hypothermia may be considered in patients with HIE and CDH or other surgical conditions with favorable prognosis.

  17. Functional laser speckle imaging of cerebral blood flow under hypothermia

    NASA Astrophysics Data System (ADS)

    Li, Minheng; Miao, Peng; Zhu, Yisheng; Tong, Shanbao

    2011-08-01

    Hypothermia can unintentionally occur in daily life, e.g., in cardiovascular surgery or applied as therapeutics in the neurosciences critical care unit. So far, the temperature-induced spatiotemporal responses of the neural function have not been fully understood. In this study, we investigated the functional change in cerebral blood flow (CBF), accompanied with neuronal activation, by laser speckle imaging (LSI) during hypothermia. Laser speckle images from Sprague-Dawley rats (n = 8, male) were acquired under normothermia (37°C) and moderate hypothermia (32°C). For each animal, 10 trials of electrical hindpaw stimulation were delivered under both temperatures. Using registered laser speckle contrast analysis and temporal clustering analysis (TCA), we found a delayed response peak and a prolonged response window under hypothermia. Hypothermia also decreased the activation area and the amplitude of the peak CBF. The combination of LSI and TCA is a high-resolution functional imaging method to investigate the spatiotemporal neurovascular coupling in both normal and pathological brain functions.

  18. Innovation possibilities for prehospital providers.

    PubMed

    Galli, Robert

    2006-01-01

    The national interest in disaster management and a burgeoning technology field are leading to the development of new approaches to emergency evaluation, triage, and treatment in prehospital and all hospital arenas. The ability to bring "hands-on" expertise, both physically and technologically, as quickly as possible to the trauma patient brings the potential for real advancement in the field. This descriptive report presents several such concepts that are moving into reality.

  19. Study on the priority of coronary arteriography or therapeutic hypothermia after return of spontaneous circulation in patients with out-of-hospital cardiac arrest: results from the SOS-KANTO 2012 study.

    PubMed

    Hagiwara, Shuichi

    2016-06-01

    Many emergency physicians struggle with the clinical question of whether to perform therapeutic hypothermia (TH) or coronary angiography (CAG) first after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). We analyzed the results of the SOS-KANTO 2012 study, which is a prospective, multicenter (67 emergency hospitals), observational study about OHCA conducted between January 2012 and March 2013 (n = 16,452). We compared two groups: the group in which TH was first performed (TH group), and the group in which CAG was performed first (CAG group) within 24 h after arrival. Two hundred and twenty-one patients were treated TH and CAG (TH group, 76 patients; CAG group, 145 patients). In addition, we selected patients who underwent coronary treatment. 164 patients underwent coronary treatment after CAG (TH group, 52 patients; CAG group, 112 patients). In patients in whom TH and CAG and coronary artery treatment were done, 42 patients (55.3 %) in the TH group and 86 patients (59.3 %) in the CAG group survived at 90 days. The cerebral performance category (CPC) 1 and 2 were 26.3 % (20 patients) in TH group, and 31.0 % (45 patients) in CAG group. In patients in whom TH and CAG with coronary artery treatment were performed, 29 patients (55.8 %) in the TH group and 64 patients (57.1 %) in the CAG group survived at 90 days. The rates of CPC 1 and 2 were 26.9 % (14 patients) in TH group, and 23.2 % (26 patients) in CAG group. There was no significant difference in 90-day survival between the two groups although it tended to be better in the CAG group than in the TH group. Whether TH or CAG was performed first did not affect the 90-day survival and 30-day neurological situation among patients with ROSC after OHCA.

  20. Optimal Protective Hypothermia in Arrested Mammalian Hearts

    PubMed Central

    Villet, Outi M.; Ge, Ming; Sekhar, Laigam N.; Corson, Marshall A.; Tylee, Tracy S.; Fan, Lu-Ping; Yao, Lin; Zhu, Chun; Olson, Aaron K.; Buroker, Norman E.; Xu, Cheng-Su; Anderson, David L.; Soh, Yong-Kian; Wang, Elise; Chen, Shi-Han; Portman, Michael A.

    2015-01-01

    Many therapeutic hypothermia recommendations have been reported, but the information supporting them is sparse, and reveals a need for the data of target therapeutic hypothermia (TTH) from well-controlled experiments. The core temperature ≤35°C is considered as hypothermia, and 29°C is a cooling injury threshold in pig heart in vivo. Thus, an optimal protective hypothermia (OPH) should be in the range 29–35°C. This study was conducted with a pig cardiopulmonary bypass preparation to decrease the core temperature to 29–35°C range at 20 minutes before and 60 minutes during heart arrest. The left ventricular (LV) developed pressure, maximum of the first derivative of LV (dP/dtmax), cardiac power, heart rate, cardiac output, and myocardial velocity (Vmax) were recorded continuously via an LV pressure catheter and an aortic flow probe. At 20 minutes of off-pump during reperfusion after 60 minutes arrest, 17 hypothermic hearts showed that the recovery of Vmax and dP/dtmax established sigmoid curves that consisted of two plateaus: a good recovery plateau at 29–30.5°C, the function recovered to baseline level (BL) (Vmax=118.4%±3.9% of BL, LV dP/dtmax=120.7%±3.1% of BL, n=6); another poor recovery plateau at 34–35°C (Vmax=60.2%±2.8% of BL, LV dP/dtmax=28.0%±5.9% of BL, p<0.05, n=6; ), which are similar to the four normothermia arrest (37°C) hearts (Vmax=55.9%±4.8% of BL, LV dP/dtmax=24.5%±2.1% of BL, n=4). The 32–32.5°C arrest hearts showed moderate recovery (n=5). A point of inflection (around 30.5–31°C) existed at the edge of a good recovery plateau followed by a steep slope. The point presented an OPH that should be the TTH. The results are concordant with data in the mammalian hearts, suggesting that the TTH should be initiated to cool core temperature at 31°C. PMID:25514569

  1. Glibenclamide enhances the effects of delayed hypothermia after experimental stroke in rats.

    PubMed

    Wu, Zhou; Zhu, Shu-Zhen; Hu, Ya-Fang; Gu, Yong; Wang, Sheng-Nan; Lin, Zhen-Zhou; Xie, Zuo-Shan; Pan, Su-Yue

    2016-07-15

    In order to evaluate whether glibenclamide can extend the therapeutic window during which induced hypothermia can protect against stroke, we subjected adult male Sprague-Dawley rats to middle cerebral artery occlusion (MCAO). We first verified the protective effects of hypothermia induced at 0, 2, 4 or 6h after MCAO onset, and then we assessed the effects of the combination of glibenclamide and hypothermia at 6, 8 or 10h after MCAO onset. At 24h after MCAO, we assessed brain edema, infarct volume, modified neurological severity score, Evans Blue leakage and expression of Sulfonylurea receptor 1 (SUR1) protein and pro-inflammatory factors. No protective effects were observed when hypothermia was induced too long after MCAO. At 6h after MCAO onset, hypothermia alone failed to decrease cerebral edema and infarct volume, but the combination of glibenclamide and hypothermia decreased both. The combination also improved neurological outcome, ameliorated blood-brain barrier damage and decreased levels of COX-2, TNF-α and IL-1β. These results suggest that glibenclamide enhances and extends the therapeutic effects of delayed hypothermia against ischemia stroke, potentially by ameliorating blood-brain barrier damage and declining levels of pro-inflammatory factors. PMID:27134036

  2. Reconsidering the role of hypothermia in management of severe traumatic brain injury.

    PubMed

    Honeybul, S

    2016-06-01

    Over the past two decades there has been considerable interest in the use of hypothermia in the management of severe traumatic brain injury. However despite promising experimental evidence, results from clinical studies have failed to demonstrate benefit. Indeed recent studies have shown a tendency to worse outcomes in those patients randomised to therapeutic hypothermia. In this narrative review the pathophysiological rationale behind hypothermia and the clinical evidence for efficacy are examined. There would still appear to be a role for hypothermia in the management of intractable intracranial hypertension. However optimising therapeutic time frames and better management of strategies for complications will be required if experimental evidence for neuroprotection is to be translated into clinical benefit. PMID:26928159

  3. Design of the PRINCESS trial: pre-hospital resuscitation intra-nasal cooling effectiveness survival study (PRINCESS)

    PubMed Central

    2013-01-01

    Background Therapeutic hypothermia (TH, 32-34°C) has been shown to improve neurological outcome in comatose survivors of out-of-hospital cardiac arrest (OHCA) with ventricular tachycardia or fibrillation. Earlier initiation of TH may increase the beneficial effects. Experimental studies have suggested that starting TH during cardiopulmonary resuscitation (CPR) may further enhance its neuroprotective effects. The aim of this study was to evaluate whether intra-arrest TH (IATH), initiated in the field with trans nasal evaporative cooling (TNEC), would provide outcome benefits when compared to standard of care in patients being resuscitated from OHCA. Methods/design We describe the methodology of a multi-centre, randomized, controlled trial comparing IATH delivered through TNEC device (Rhinochill, Benechill Inc., San Diego, CA, USA) during CPR to standard treatment, including TH initiated after hospital admission. The primary outcome is neurological intact survival defined as cerebral performance category 1–2 at 90 days among those patients who are admitted to the hospital. Secondary outcomes include survival at 90 days, proportion of patients achieving a return to spontaneous circulation (ROSC), the proportion of patients admitted alive to the hospital and the proportion of patients achieving target temperature (<34°C) within the first 4 hours since CA. Discussion This ongoing trial will assess the impact of IATH with TNEC, which may be able to rapidly induce brain cooling and have fewer side effects than other methods, such as cold fluid infusion. If this intervention is found to improve neurological outcome, its early use in the pre-hospital setting will be considered as an early neuro-protective strategy in OHCA. Trial registration NCT01400373. PMID:24274342

  4. Adult Status Epilepticus: A Review of the Prehospital and Emergency Department Management.

    PubMed

    Billington, Michael; Kandalaft, Osama R; Aisiku, Imoigele P

    2016-01-01

    Seizures are a common presentation in the prehospital and emergency department setting and status epilepticus represents an emergency neurologic condition. The classification and various types of seizures are numerous. The objectives of this narrative literature review focuses on adult patients with a presentation of status epilepticus in the prehospital and emergency department setting. In summary, benzodiazepines remain the primary first line therapeutic agent in the management of status epilepticus, however, there are new agents that may be appropriate for the management of status epilepticus as second- and third-line pharmacological agents. PMID:27563928

  5. Adult Status Epilepticus: A Review of the Prehospital and Emergency Department Management

    PubMed Central

    Billington, Michael; Kandalaft, Osama R.; Aisiku, Imoigele P.

    2016-01-01

    Seizures are a common presentation in the prehospital and emergency department setting and status epilepticus represents an emergency neurologic condition. The classification and various types of seizures are numerous. The objectives of this narrative literature review focuses on adult patients with a presentation of status epilepticus in the prehospital and emergency department setting. In summary, benzodiazepines remain the primary first line therapeutic agent in the management of status epilepticus, however, there are new agents that may be appropriate for the management of status epilepticus as second- and third-line pharmacological agents. PMID:27563928

  6. Halting Hypothermia: Cold Can Be Dangerous

    MedlinePlus

    ... who spends much time outdoors in very cold weather can get hypothermia. But hypothermia can happen anywhere— ... just outside and not just in bitter winter weather. It can strike when temperatures are cool—for ...

  7. [Accidental hypothermia (a case report)].

    PubMed

    Erkalp, Kerem; Yangin, Zehra; Başaranoğlu, Gökçen; Erden, Veysel

    2006-07-01

    Severe accidental hypothermia (core body temperature of less than 28 degrees C) is a life threatening state and a medical emergency associated with a high mortality rate. The prognosis depends on underlying diseases, advanced or very early age, the duration prior to treatment, the degree of hemodynamic deterioration, and especially, the methods of treatment, including active external or internal rewarming. We report a 70-year-old male patient with severe accidental hypothermia (core temperature 28 degrees C). The homeless man was found in the street. He died, in spite of all resuscitation efforts and rewarming methods. In this case report reviews the epidemiology, pathophysiology, clinical presentation, and treatment of accidental hypothermia. PMID:16850366

  8. Limitations of Mild, Moderate, and Profound Hypothermia in Protecting Developing Hippocampal Neurons After Simulated Ischemia

    PubMed Central

    Gregersen, Maren; Lee, Deok Hee; Gabatto, Pablo

    2013-01-01

    Mild hypothermia (33°C–34°C) after cerebral ischemia in intact animals or ischemia-like conditions in vitro reduces neuron death. However, it is now clear that more profound hypothermia or delayed hypothermia may not provide significant protection. To further define the limitations of hypothermia after cerebral ischemia, we used hippocampal slice cultures to examine the effects of various degrees, durations, and delays of hypothermia on neuron death after an ischemia-like insult. Organotypic cultures of the hippocampus from 7- to 8 day-old rat pups were cooled to 32°C, 23°C, 17°C, or 4°C immediately or after a 2–4 hour delay from an injurious insult of oxygen and glucose deprivation (OGD). Cell death in CA1, CA3 and dentate regions of the cultures was assessed 24 hours later with SYTOX® or propidium iodide, both of which are fluorescent markers labeling damaged cells. OGD caused extensive cell death in CA1, CA3, and dentate regions of the hippocampal cultures. Hypothermia (32°C, 23°C and 17°C) for 4–6 hours immediately after OGD was protective at 24 hours, but when hypothermia was applied for longer periods or delayed after OGD, no protection or increased death was seen. Ultra-profound hypothermia (4°C) increased cell death in all cell areas of the hippocampus even when after a milder insult of only hypoxia. In an in vitro model of recovery after an ischemia-like insult, mild to profound hypothermia is protective only when applied without delay and for limited periods of time (6–8 hours). Longer durations of hypothermia, or delayed application of the hypothermia can increase neuron death. These findings may have implications for clinical uses of therapeutic hypothermia after hypoxic or ischemic insults, and suggest that further work is needed to elucidate the limitations of hypothermia as a protective treatment after ischemic stress. PMID:24380031

  9. Prehospital Burn Care for Emergency Medical Technicians.

    ERIC Educational Resources Information Center

    Lindstrom, Robert A.; And Others

    1978-01-01

    Describes the development, objectives, content, and evaluation of a unique, 60-minute, synchronized slide/tape program on prehospital burn care for emergency medical technicians; and presents a design for valid content-reference formative evaluation. (Author/VT)

  10. The Osborn wave in hypothermia.

    PubMed

    Gould, L; Gopalaswamy, C; Kim, B S; Patel, C

    1985-02-01

    A patient is reported who presented with fatal hypothermia. The electrocardiographic changes of a sinus bradycardia, prolonged QT interval and Osborn waves were documented and correlated with body temperature. The possible genesis of these electrocardiographic changes is reviewed in this article. PMID:4025922

  11. The Cold Blooded Killer: Hypothermia.

    ERIC Educational Resources Information Center

    Keller, Rosanne

    Part of a series of home literacy readers with conversational text and sketches, this booklet depicts the subarctic Alaskan environment where cold makes extreme demands on body metabolism. Body temperature must be maintained above 80F (26.7C). A condition of too little body-heat is termed hypo- ('deficit') thermia ('heat'). Hypothermia is the…

  12. [Hypothermia--mechanism of action and pathophysiological changes in the human body].

    PubMed

    Sosnowski, Przemysław; Mikrut, Kinga; Krauss, Hanna

    2015-01-16

    This review focuses on the physiological responses and pathophysiological changes induced by hypothermia. Normal body function depends on its ability to maintain thermal homeostasis. The human body can be divided arbitrarily into two thermal compartments: a core compartment (trunk and head), with precisely regulated temperature around 37°C, and a peripheral compartment (skin and extremities) with less strictly controlled temperature, and lower than the core temperature. Thermoregulatory processes occur in three phases: afferent thermal sensing, central regulation, mainly by the preoptic area of the anterior hypothalamus, and efferent response. Exposure to cold induces thermoregulatory responses including cutaneous vasoconstriction, shivering and non-shivering thermogenesis, and behavioral changes. Alterations of body temperature associated with impaired thermoregulation, decreased heat production or increased heat loss can lead to hypothermia. Hypothermia is defined as a core body temperature below 35ºC, and may be classified according to the origin as accidental (e.g. caused by exposure to a cold environment, drugs, or illness) or intentional (i.e. therapeutic), or by the degree of hypothermia as mild, moderate or severe. Classification by temperature is not universal. Lowering of body temperature disrupts the physiological processes at the molecular, cellular and system level, but hypothermia induced prior to cardiosurgical or neurosurgical procedures, by the decrease in tissue oxygen demand, can reduce the risk of cerebral or cardiac ischemic damage. Therapeutic hypothermia has been recommended as a clinical procedure in situations characterized by ischemia, such as cardiac arrest, stroke and brain injuries.

  13. Mild hypothermia as a cardioprotective approach for acute myocardial infarction: laboratory to clinical application.

    PubMed

    Hale, Sharon L; Kloner, Robert A

    2011-06-01

    In many animal models, mild therapeutic hypothermia is a powerful intervention, reducing myocardial infarct size, reducing the no-reflow phenomenon, and improving healing after infarction. Cooling in these models has been produced by various means including whole-body hypothermia, synchronized hypothermic coronary venous retro-perfusion, heat exchangers, and regional hypothermia targeting the heart alone. However, in humans, the most widely used techniques are surface cooling and cooling by endovascular heat-exchange catheters. The reduction in temperature necessary to produce cardioprotection is mild (32-34°C), appears to have no detrimental effects on left ventricular function or regional myocardial blood flow, and may improve microvascular reflow to previously ischemic heart tissue. It has been shown in experimental and clinical studies that for therapeutic hypothermia to be effective it must be (1) initiated as early as possible after the onset of ischemia and (2) initiated before reperfusion. This may require initiation of hypothermia in the ambulance, well before mechanical reperfusion occurs. The mechanisms of protection produced by hypothermia have yet to be conclusively determined but may include a decrease in tissue metabolic rate, preservation of high energy phosphates, a reduction in tissue apoptosis or induction of heat shock proteins.

  14. Hypothermia, immune suppression and SDD: can we have our cake and eat it?

    PubMed Central

    2011-01-01

    In vitro studies and clinical observations suggest that both accidental and controlled/therapeutic hypothermia have a strong immunosuppressive effect, and that hypothermia increases the risk of infections, especially wound infections and pneumonia. In the previous issue of Critical Care, Kamps and colleagues report that when hypothermia was used for prolonged periods in patients with severe traumatic brain injury in conjunction with selective decontamination of the digestive tract, the risks of infection were the same or lower in patients treated with therapeutic cooling. The risk of infection is widely regarded as the most important danger of therapeutic cooling. The findings of Kamps and colleagues need to be verified in prospective trials and in higher-resistance environments, but raise the possibility of cooling for prolonged periods with greatly reduced risk. We may be able to have our cake and eat it. PMID:21489332

  15. Activation of mitochondrial STAT-3 and reduced mitochondria damage during hypothermia treatment for post-cardiac arrest myocardial dysfunction.

    PubMed

    Huang, Chien-Hua; Tsai, Min-Shan; Chiang, Chih-Yen; Su, Yu-Jen; Wang, Tzung-Dau; Chang, Wei-Tien; Chen, Huei-Wen; Chen, Wen-Jone

    2015-11-01

    While therapeutic hypothermia improves the outcomes of individuals in cardiac arrest, the hemodynamic responses and mechanisms which underlie hypothermia-induced cardioprotection are not fully understood. Therefore, we investigated the mechanism by which induced hypothermia preserves cardiac function and protects against mitochondrial damage following cardiac arrest. Cardiac arrest was induced in adult male Wistar rats by asphyxiation for 8.5 min. Following resuscitation, the animals were randomly assigned to a hypothermia (32 °C) or normothermia (37 °C) group. Monitoring results showed that cardiac output at the fourth hour after resuscitation was significantly better in rats treated with hypothermia when compared to rats treated with normothermia (P < 0.01). Examinations by transmission electron microscopy showed that mitochondria in the left ventricle of rats in the hypothermia group were significantly less swollen compared to such mitochondria in the normothermia group (P < 0.001). Additionally, opening of mitochondrial permeability transition pores occurred less frequently in the hypothermic group. While complex I/III activity in the electron transport reaction was damaged after cardiac arrest and resuscitation, the degree of injury was ameliorated by hypothermia treatment (P < 0.05). The amount of STAT-3 phosphorylated at tyrosine 705 and its expression in mitochondria were significantly higher under hypothermia treatment compared to normothermia treatment. In vitro studies showed that inhibition STAT-3 activation abolished the ability of hypothermia to protect H9C2 cardiomyocytes against injury produced by simulated ischemia and reperfusion. Therapeutic hypothermia treatment can ameliorate cardiac dysfunction and help preserve both mitochondrial integrity and electron transport activity. PMID:26471891

  16. Activation of mitochondrial STAT-3 and reduced mitochondria damage during hypothermia treatment for post-cardiac arrest myocardial dysfunction.

    PubMed

    Huang, Chien-Hua; Tsai, Min-Shan; Chiang, Chih-Yen; Su, Yu-Jen; Wang, Tzung-Dau; Chang, Wei-Tien; Chen, Huei-Wen; Chen, Wen-Jone

    2015-11-01

    While therapeutic hypothermia improves the outcomes of individuals in cardiac arrest, the hemodynamic responses and mechanisms which underlie hypothermia-induced cardioprotection are not fully understood. Therefore, we investigated the mechanism by which induced hypothermia preserves cardiac function and protects against mitochondrial damage following cardiac arrest. Cardiac arrest was induced in adult male Wistar rats by asphyxiation for 8.5 min. Following resuscitation, the animals were randomly assigned to a hypothermia (32 °C) or normothermia (37 °C) group. Monitoring results showed that cardiac output at the fourth hour after resuscitation was significantly better in rats treated with hypothermia when compared to rats treated with normothermia (P < 0.01). Examinations by transmission electron microscopy showed that mitochondria in the left ventricle of rats in the hypothermia group were significantly less swollen compared to such mitochondria in the normothermia group (P < 0.001). Additionally, opening of mitochondrial permeability transition pores occurred less frequently in the hypothermic group. While complex I/III activity in the electron transport reaction was damaged after cardiac arrest and resuscitation, the degree of injury was ameliorated by hypothermia treatment (P < 0.05). The amount of STAT-3 phosphorylated at tyrosine 705 and its expression in mitochondria were significantly higher under hypothermia treatment compared to normothermia treatment. In vitro studies showed that inhibition STAT-3 activation abolished the ability of hypothermia to protect H9C2 cardiomyocytes against injury produced by simulated ischemia and reperfusion. Therapeutic hypothermia treatment can ameliorate cardiac dysfunction and help preserve both mitochondrial integrity and electron transport activity.

  17. Prehospital management of traumatic brain injury.

    PubMed

    Stiver, Shirley I; Manley, Geoffrey T

    2008-10-01

    The aim of this study was to review the current protocols of prehospital practice and their impact on outcome in the management of traumatic brain injury. A literature review of the National Library of Medicine encompassing the years 1980 to May 2008 was performed. The primary impact of a head injury sets in motion a cascade of secondary events that can worsen neurological injury and outcome. The goals of care during prehospital triage, stabilization, and transport are to recognize life-threatening raised intracranial pressure and to circumvent cerebral herniation. In that process, prevention of secondary injury and secondary insults is a major determinant of both short- and longterm outcome. Management of brain oxygenation, blood pressure, cerebral perfusion pressure, and raised intracranial pressure in the prehospital setting are discussed. Patient outcomes are dependent upon an organized trauma response system. Dispatch and transport timing, field stabilization, modes of transport, and destination levels of care are addressed. In addition, special considerations for mass casualty and disaster planning are outlined and recommendations are made regarding early response efforts and the ethical impact of aggressive prehospital resuscitation. The most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of prehospital care is a major determinant of long-term outcome for patients with traumatic brain injury.

  18. The prehospital management of traumatic brain injury.

    PubMed

    Goldberg, Scott A; Rojanasarntikul, Dhanadol; Jagoda, Andrew

    2015-01-01

    Traumatic brain injury (TBI) is an important cause of death and disability, particularly in younger populations. The prehospital evaluation and management of TBI is a vital link between insult and definitive care and can have dramatic implications for subsequent morbidity. Following a TBI the brain is at high risk for further ischemic injury, with prehospital interventions targeted at reducing this secondary injury while optimizing cerebral physiology. In the following chapter we discuss the prehospital assessment and management of the brain-injured patient. The initial evaluation and physical examination are discussed with a focus on interpretation of specific physical examination findings and interpretation of vital signs. We evaluate patient management strategies including indications for advanced airway management, oxygenation, ventilation, and fluid resuscitation, as well as prehospital strategies for the management of suspected or impending cerebral herniation including hyperventilation and brain-directed hyperosmolar therapy. Transport decisions including the role of triage models and trauma centers are discussed. Finally, future directions in the prehospital management of traumatic brain injury are explored.

  19. Role of neurotensin in radiation-induced hypothermia in rats

    SciTech Connect

    Kandasamy, S.B.; Hunt, W.A.; Harris, A.H. )

    1991-05-01

    The role of neurotensin in radiation-induced hypothermia was examined. Intracerebroventricular (ICV) administration of neurotensin produced dose-dependent hypothermia. Histamine appears to mediate neurotensin-induced hypothermia because the mast cell stabilizer disodium cromoglycate and antihistamines blocked the hypothermic effects of neurotensin. An ICV pretreatment with neurotensin antibody attenuated neurotensin-induced hypothermia, but did not attenuate radiation-induced hypothermia, suggesting that radiation-induced hypothermia was not mediated by neurotensin.

  20. The big chill: accidental hypothermia.

    PubMed

    Davis, Robert Allan

    2012-01-01

    A potential cause of such emergent issues as cardiac arrhythmias, hypotension, and fluid and electrolyte shifts, accidental hypothermia can be deadly, is common among trauma patients, and is often difficult to recognize. The author discusses predisposing conditions, the classic presentation, and the effects on normal thermoregulatory processes; explains how to conduct a systems assessment of the hypothermic patient; and describes crucial management strategies. PMID:22186703

  1. Myocardial protection with mild hypothermia.

    PubMed

    Tissier, Renaud; Ghaleh, Bijan; Cohen, Michael V; Downey, James M; Berdeaux, Alain

    2012-05-01

    Mild hypothermia, 32-35° C, is very potent at reducing myocardial infarct size in rabbits, dogs, sheep, pigs, and rats. The benefit is directly related to reduction in normothermic ischaemic time, supporting the relevance of early and rapid cooling. The cardioprotective effect of mild hypothermia is not limited to its recognized reduction of infarct size, but also results in conservation of post-ischaemic contractile function, prevention of no-reflow or microvascular obstruction, and ultimately attenuation of left ventricular remodelling. The mechanism of the anti-infarct effect does not appear to be related to diminished energy utilization and metabolic preservation, but rather to survival signalling that involves either the extracellular signal-regulated kinases and/or the Akt/phosphoinositide 3-kinase/mammalian target of rapamycin pathways. Initial clinical trials of hypothermia in patients with ST-segment elevation myocardial infarction were disappointing, probably because cooling was too slow to shorten normothermic ischaemic time appreciably. New approaches to more rapid cooling have recently been described and may soon be available for clinical use. Alternatively, it may be possible to pharmacologically mimic the protection provided by cooling soon after the onset of ischaemia with an activator of mild hypothermia signalling, e.g. extracellular signal-regulated kinase activator, that could be given by emergency medical personnel. Finally, the protection afforded by cooling can be added to that of pre- and post-conditioning because their mechanisms differ. Thus, myocardial salvage might be greatly increased by rapidly cooling patients as soon as possible and then giving a pharmacological post-conditioning agent immediately prior to reperfusion. PMID:22131353

  2. Management of pitfalls for the successful clinical use of hypothermia treatment.

    PubMed

    Hayashi, Nariyuki

    2009-03-01

    Therapeutic hypothermia is a promising method for controlling intracranial pressure (ICP) in severely brain-injured patients. However, clinical data regarding the effect of brain hypothermia on overall outcome of these patients is limited. This may be because there are specific pitfalls associated with the clinical management of induced hypothermia in patients with severe traumatic brain injury (TBI). These pitfalls may be avoided by preventing specific risk factors when cooling is induced and with rewarming. However, these risk factors have not been well systematically discussed in the literature. In this paper, three categories of clinical issues regarding the management of brain hypothermia are discussed: (1) stress-induced secondary brain injury mechanisms; (2) technical aspects of intensive care unit (ICU) cooling management; and (3) rewarming rates and methods. For patients with a Glasgow Coma Scale (GCS) score of less than 8, management of stress-induced insulin-resistant hyperglycemia, and unstable systemic circulation due to impaired cardiac contractility are especially important. For example, in our experience, posttraumatic hyperglycemia, exacerbated by cooling, may be ameliorated by the administration of a ketone body with mannitol. Prevention of selective free radical damage to neurons is also an important target for successful brain hypothermia treatment. Taken together, it is clear that several orchestrated steps should be initiated to enhance the protective effects of hypothermia therapy and prevent these possible pitfalls. PMID:19292696

  3. Dantrolene enhances the protective effect of hypothermia on cerebral cortex neurons

    PubMed Central

    Xu, Sui-yi; Hu, Feng-yun; Ren, Li-jie; Chen, Lei; Zhou, Zhu-qing; Zhang, Xie-jun; Li, Wei-ping

    2015-01-01

    Therapeutic hypothermia is the most promising non-pharmacological neuroprotective strategy against ischemic injury. However, shivering is the most common adverse reaction. Many studies have shown that dantrolene is neuroprotective in in vitro and in vivo ischemic injury models. In addition to its neuroprotective effect, dantrolene neutralizes the adverse reaction of hypothermia. Dantrolene may be an effective adjunctive therapy to enhance the neuroprotection of hypothermia in treating ischemic stroke. Cortical neurons isolated from rat fetuses were exposed to 90 minutes of oxygen-glucose deprivation followed by reoxygenation. Neurons were treated with 40 μM dantrolene, hypothermia (at 33°C), or the combination of both for 12 hours. Results revealed that the combination of dantrolene and hypothermia increased neuronal survival and the mitochondrial membrane potential, and reduced intracellular active oxygen cytoplasmic histone-associated DNA fragmentation, and apoptosis. Furthermore, improvements in cell morphology were observed. The combined treatment enhanced these responses compared with either treatment alone. These findings indicate that dantrolene may be used as an effective adjunctive therapy to enhance the neuroprotective effects of hypothermia in ischemic stroke. PMID:26487856

  4. Prehospital care in Hong Kong.

    PubMed

    Lo, C B; Lai, K K; Mak, K P

    2000-09-01

    A quick and efficient prehospital emergency response depends on immediate ambulance dispatch, patient assessment, triage, and transport to hospital. During 1999, the Ambulance Command of the Hong Kong Fire Services Department responded to 484,923 calls, which corresponds to 1329 calls each day. Cooperation between the Fire Services Department and the Hospital Authority exists at the levels of professional training of emergency medical personnel, quality assurance, and a coordinated disaster response. In response to the incident at the Hong Kong International Airport in the summer of 1999, when an aircraft overturned during landing, the pre-set quota system was implemented to send patients to designated accident and emergency departments. Furthermore, the 'first crew at the scene' model has been adopted, whereby the command is established and triage process started by the first ambulance crew members to reach the scene. The development of emergency protocols should be accompanied by good field-to-hospital and interhospital communication, the upgrading of decision-making skills, a good monitoring and auditing structure, and commitment to training and skills maintenance.

  5. A consensus-based template for documenting and reporting in physician-staffed pre-hospital services

    PubMed Central

    2011-01-01

    Background Physician-staffed pre-hospital units are employed in many Western emergency medical services (EMS) systems. Although these services usually integrate well within their EMS, little is known about the quality of care delivered, the precision of dispatch, and whether the services deliver a higher quality of care to pre-hospital patients. There is no common data set collected to document the activity of physician pre-hospital activity which makes shared research efforts difficult. The aim of this study was to develop a core data set for routine documentation and reporting in physician-staffed pre-hospital services in Europe. Methods Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary meeting in Stavanger, Norway. Results The core data set was divided into 5 sections: "fixed system variables", "event operational descriptors", " patient descriptors", "process mapping", and "outcome measures and quality indicators". After the initial round, a total of 361 variables were proposed by the experts. Subsequent rounds reduced the number of core variables to 45. These constituted the final core data set. Emphasis was placed on the standardisation of reporting time variables, chief complaints and diagnostic and therapeutic procedures. Conclusions Using a modified nominal group technique, we have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre-hospital care. PMID:22107787

  6. Commercial filming of prehospital patient care

    PubMed Central

    Godfrey, P D; Henning, J D

    2007-01-01

    Commercial filming of patients in the hospital and now the prehospital environment is becoming increasingly common. Television programmes that focus on medical emergencies with real footage of events remain highly successful and can make compelling viewing for both medical professionals and the general public alike. Recently several commentators have questioned the ethical aspects of filming in hospital emergency departments, and noted the lack of available evidence. This article reviews commercial filming and its impact in the prehospital environment and examines the ethical implications and current guidance in this unique setting. PMID:18029523

  7. [Hypothermia. Physiopathology, clinical picture and treatment].

    PubMed

    Christensen, C

    1990-08-01

    Hypothermia is defined as a lowering of core body temperature to 35 degrees C or below. Hypothermia may be advantageous in connexion with cardiac surgery or it may be fatal in connexion with accidental hypothermia. Accidental hypothermia is a problem which may be underestimated because of limited awareness. Severe hypothermia occurs when the body temperature falls below 28 degrees C. The patient may be unconscious, with such severely depressed vital signs that he appears to be dead. All such patients should undergo cardiopulmonary resuscitation in addition to rewarming, because reliable determination of death is nearly impossible without the restoration of adequate cardiovascular support, maintaining serum acid base balance, arterial oxygenation and intravascular volume levels within appropriate physiological ranges. Three controversial issues in connexion with treatment of the hypothermic patient are reviewed. These are correction of blood gas analyses, the phenomenon of afterdrop and cardiopulmonary resuscitation. PMID:2205036

  8. Extending the duration of hypothermia does not further improve white matter protection after ischemia in term-equivalent fetal sheep

    PubMed Central

    Davidson, Joanne O.; Yuill, Caroline A.; Zhang, Frank G.; Wassink, Guido; Bennet, Laura; Gunn, Alistair J.

    2016-01-01

    A major challenge in modern neonatal care is to further improve outcomes after therapeutic hypothermia for hypoxic ischemic encephalopathy. In this study we tested whether extending the duration of cooling might reduce white matter damage. Term-equivalent fetal sheep (0.85 gestation) received either sham ischemia followed by normothermia (n = 8) or 30 minutes of bilateral carotid artery occlusion followed by three days of normothermia (n = 8), three days of hypothermia (n = 8) or five days of hypothermia (n = 8) started three hours after ischemia. Histology was assessed 7 days after ischemia. Ischemia was associated with loss of myelin basic protein (MBP) and Olig-2 positive oligodendrocytes and increased Iba-1-positive microglia compared to sham controls (p < 0.05). Three days and five days of hypothermia were associated with a similar, partial improvement in MBP and numbers of oligodendrocytes compared to ischemia-normothermia (p < 0.05). Both hypothermia groups had reduced microglial activation compared to ischemia-normothermia (p < 0.05). In the ischemia-five-day hypothermia group, but not ischemia-three-day, numbers of microglia remained higher than in sham controls (p < 0.05). In conclusion, delayed cerebral hypothermia partially protected white matter after global cerebral ischemia in fetal sheep. Extending cooling from 3 to 5 days did not further improve outcomes, and may be associated with greater numbers of residual microglia. PMID:27121655

  9. Extending the duration of hypothermia does not further improve white matter protection after ischemia in term-equivalent fetal sheep.

    PubMed

    Davidson, Joanne O; Yuill, Caroline A; Zhang, Frank G; Wassink, Guido; Bennet, Laura; Gunn, Alistair J

    2016-01-01

    A major challenge in modern neonatal care is to further improve outcomes after therapeutic hypothermia for hypoxic ischemic encephalopathy. In this study we tested whether extending the duration of cooling might reduce white matter damage. Term-equivalent fetal sheep (0.85 gestation) received either sham ischemia followed by normothermia (n = 8) or 30 minutes of bilateral carotid artery occlusion followed by three days of normothermia (n = 8), three days of hypothermia (n = 8) or five days of hypothermia (n = 8) started three hours after ischemia. Histology was assessed 7 days after ischemia. Ischemia was associated with loss of myelin basic protein (MBP) and Olig-2 positive oligodendrocytes and increased Iba-1-positive microglia compared to sham controls (p < 0.05). Three days and five days of hypothermia were associated with a similar, partial improvement in MBP and numbers of oligodendrocytes compared to ischemia-normothermia (p < 0.05). Both hypothermia groups had reduced microglial activation compared to ischemia-normothermia (p < 0.05). In the ischemia-five-day hypothermia group, but not ischemia-three-day, numbers of microglia remained higher than in sham controls (p < 0.05). In conclusion, delayed cerebral hypothermia partially protected white matter after global cerebral ischemia in fetal sheep. Extending cooling from 3 to 5 days did not further improve outcomes, and may be associated with greater numbers of residual microglia.

  10. Hypothermia, torpor and the fundamental importance of understanding the central control of thermoregulation.

    PubMed

    Tupone, Domenico; Morrison, Shaun

    2014-01-01

    Activation of central adenosine A1 receptors in the rat, a non-hibernating species, mimics the physiological characteristics of torpor and could thus represent a basis for the development of pharmacological approaches to induce therapeutic hypothermia in pathologies such as brain hemorrhage and ischemia, and to facilitate long-term space travel.

  11. Hypothermia, torpor and the fundamental importance of understanding the central control of thermoregulation

    PubMed Central

    Tupone, Domenico; Morrison, Shaun

    2014-01-01

    Activation of central adenosine A1 receptors in the rat, a non-hibernating species, mimics the physiological characteristics of torpor and could thus represent a basis for the development of pharmacological approaches to induce therapeutic hypothermia in pathologies such as brain hemorrhage and ischemia, and to facilitate long-term space travel. PMID:27583286

  12. Hypothermia for hypoxic–ischemic encephalopathy

    PubMed Central

    Cotten, C Michael; Shankaran, Seetha

    2010-01-01

    Moderate to severe hypoxic–ischemic injury in newborn infants, manifested as encephalopathy immediately or within hours after birth, is associated with a high risk of either death or a lifetime with disability. In recent multicenter clinical trials, hypothermia initiated within the first 6 postnatal hours has emerged as a therapy that reduces the risk of death or impairment among infants with hypoxic–ischemic encephalopathy. Prior to hypothermia, no therapies directly targeting neonatal encephalopathy secondary to hypoxic–ischemic injury had convincing evidence of efficacy. Hypothermia therapy is now becoming increasingly available at tertiary centers. Despite the deserved enthusiasm for hypothermia, obstetric and neonatology caregivers, as well as society at large, must be reminded that in the clinical trials more than 40% of cooled infants died or survived with impairment. Although hypothermia is an evidence-based therapy, additional discoveries are needed to further improve outcome after HIE. In this article, we briefly present the epidemiology of neonatal encephalopathy due to hypoxic–ischemic injury, describe the rationale for the use of hypothermia therapy for hypoxic–ischemic encephalopathy, and present results of the clinical trials that have demonstrated the efficacy of hypothermia. We also present findings noted during and after these trials that will guide care and direct research for this devastating problem. PMID:20625441

  13. The EKG in hypothermia and hyperthermia.

    PubMed

    Doshi, Hardik H; Giudici, Michael C

    2015-01-01

    Hypothermia and hyperthermia are relatively common clinical conditions that are associated with significant morbidity and mortality, especially if not promptly recognized and treated. Both of these conditions associated with extreme alterations in core body temperatures can be accompanied by alteration in cardiac function, often with manifest EKG changes. However, some of the EKG changes associated with hypothermia and heat stroke are non-specific and lead to diagnostic dilemmas. We here present 2 clinical cases, one each for hypothermia and hyperthermia to describe the EKG changes associated with these clinical conditions. We also present a review of available literature on these subjects.

  14. Atomoxetine Induced Hypothermia: A Case Report

    PubMed Central

    Abali, Osman; Yilmaz, Onat

    2011-01-01

    Adverse drug reactions are common in drugs used during childhood and adolescence. Atomoxetine, a selective reuptake inhibitor, was introduced as a safe non-stimulant alternative treatment for attention deficit hyperactivity disorder. Described common side effects of atomoxetine include: headache, abdominal pain, decreased appetite, fatigue, nausea, vomiting and dizziness. In our case, we present an adolescent male who developed hypothermia under atomoxetine treatment. To our knowledge, this is the first report of a causal connection between atomoxetine intake and hypothermia. Because hypothermia is a life-threatening condition and can be treated when interfered immediately, clinicians should be aware of this adverse effect of atomoxetine.

  15. Pediatric nonenvironmental hypothermia presenting to the emergency department: Episodic spontaneous hypothermia with hyperhidrosis.

    PubMed

    Greenberg, Richard A; Rittichier, Kristine K

    2003-02-01

    Cases of pediatric nonenvironmental hypothermia are uncommon. When presenting to the emergency department, these patients are often evaluated for possible sepsis/shock, brain tumors, endocrine disorders, and drug ingestions. We report a case of a 5-year-old girl who presented to the pediatric emergency department on two occasions with hypothermia and lethargy. She was found to have an unusual cause of her symptoms: episodic spontaneous hypothermia with hyperhidrosis. PMID:12592112

  16. White matter apoptosis is increased by delayed hypothermia and rewarming in a neonatal piglet model of hypoxic ischemic encephalopathy.

    PubMed

    Wang, B; Armstrong, J S; Reyes, M; Kulikowicz, E; Lee, J-H; Spicer, D; Bhalala, U; Yang, Z-J; Koehler, R C; Martin, L J; Lee, J K

    2016-03-01

    Therapeutic hypothermia is widely used to treat neonatal hypoxic ischemic (HI) brain injuries. However, potentially deleterious effects of delaying the induction of hypothermia and of rewarming on white matter injury remain unclear. We used a piglet model of HI to assess the effects of delayed hypothermia and rewarming on white matter apoptosis. Piglets underwent HI injury or sham surgery followed by normothermic or hypothermic recovery at 2h. Hypothermic groups were divided into those with no rewarming, slow rewarming at 0.5°C/h, or rapid rewarming at 4°C/h. Apoptotic cells in the subcortical white matter of the motor gyrus, corpus callosum, lateral olfactory tract, and internal capsule at 29h were identified morphologically and counted by hematoxylin & eosin staining. Cell death was verified by terminal deoxynucleotidyl transferase (TdT) dUTP nick end labeling (TUNEL) assay. White matter neurons were also counted, and apoptotic cells were immunophenotyped with the oligodendrocyte marker 2',3'-cyclic-nucleotide 3'-phosphodiesterase (CNPase). Hypothermia, slow rewarming, and rapid rewarming increased apoptosis in the subcortical white matter relative to normothermia (p<0.05). The number of white matter neurons was not lower in groups with more apoptosis after hypothermia or rapid rewarming, indicating that the apoptosis occurred among glial cells. Hypothermic piglets had more apoptosis in the lateral olfactory tract than those that were rewarmed (p<0.05). The promotion of apoptosis by hypothermia and rewarming in these regions was independent of HI. In the corpus callosum, HI piglets had more apoptosis than shams after normothermia, slow rewarming, and rapid rewarming (p<0.05). Many apoptotic cells were myelinating oligodendrocytes identified by CNPase positivity. Our results indicate that delaying the induction of hypothermia and rewarming are associated with white matter apoptosis in a piglet model of HI; in some regions these temperature effects are

  17. The Effects of Local and General Hypothermia on Temperature Profiles of the Central Nervous System Following Spinal Cord Injury in Rats

    PubMed Central

    Bazley, Faith A.; Pashai, Nikta; Kerr, Candace L.

    2014-01-01

    Local and general hypothermia are used to treat spinal cord injury (SCI), as well as other neurological traumas. While hypothermia is known to provide significant therapeutic benefits due to its neuroprotective nature, it is unclear how the treatment may affect healthy tissues or whether it may cause undesired temperature changes in areas of the body that are not the targets of treatment. We performed 2-hour moderate general hypothermia (32°C core) or local hypothermia (30°C spinal cord) on rats that had received either a moderate contusive SCI or laminectomy (control) while monitoring temperatures at three sites: the core, spinal cord, and cortex. First, we identified that injured rats that received general hypothermia exhibited larger temperature drops at the spinal cord (−3.65°C, 95% confidence intervals [CIs] −3.72, −3.58) and cortex (−3.64°C, CIs −3.73, −3.55) than uninjured rats (spinal cord: −3.17°C, CIs −3.24, −3.10; cortex: −3.26°C, CIs −3.34, −3.17). This was found due to elevated baseline temperatures in the injured group, which could be due to inflammation. Second, both general hypothermia and local hypothermia caused a significant reduction in the cortical temperature (−3.64°C and −1.18°C, respectively), although local hypothermia caused a significantly lower drop in cortical temperature than general hypothermia (p<0.001). Lastly, the rates of rewarming of the cord were not significantly different among the methods or injury groups that were tested; the mean rate of rewarming was 0.13±0.1°C/min. In conclusion, local hypothermia may be more suitable for longer durations of hypothermia treatment for SCI to reduce temperature changes in healthy tissues, including the cortex. PMID:25019643

  18. Taking the Blood Bank to the Field: The Design and Rationale of the Prehospital Air Medical Plasma (PAMPer) Trial.

    PubMed

    Brown, Joshua B; Guyette, Francis X; Neal, Matthew D; Claridge, Jeffrey A; Daley, Brian J; Harbrecht, Brian G; Miller, Richard S; Phelan, Herb A; Adams, Peter W; Early, Barbara J; Peitzman, Andrew B; Billiar, Timothy R; Sperry, Jason L

    2015-01-01

    Hemorrhage and trauma induced coagulopathy remain major drivers of early preventable mortality in military and civilian trauma. Interest in the use of prehospital plasma in hemorrhaging patients as a primary resuscitation agent has grown recently. Trauma center-based damage control resuscitation using early and aggressive plasma transfusion has consistently demonstrated improved outcomes in hemorrhaging patients. Additionally, plasma has been shown to have several favorable immunomodulatory effects. Preliminary evidence with prehospital plasma transfusion has demonstrated feasibility and improved short-term outcomes. Applying state-of-the-art resuscitation strategies to the civilian prehospital arena is compelling. We describe here the rationale, design, and challenges of the Prehospital Air Medical Plasma (PAMPer) trial. The primary objective is to determine the effect of prehospital plasma transfusion during air medical transport on 30-day mortality in patients at risk for traumatic hemorrhage. This study is a multicenter cluster randomized clinical trial. The trial will enroll trauma patients with profound hypotension (SBP ≤ 70 mmHg) or hypotension (SBP 71-90 mmHg) and tachycardia (HR ≥ 108 bpm) from six level I trauma center air medical transport programs. The trial will also explore the effects of prehospital plasma transfusion on the coagulation and inflammatory response following injury. The trial will be conducted under exception for informed consent for emergency research with an investigational new drug approval from the U.S. Food and Drug Administration utilizing a multipronged community consultation process. It is one of three ongoing Department of Defense-funded trials aimed at expanding our understanding of the optimal therapeutic approaches to coagulopathy in the hemorrhaging trauma patient.

  19. Normal saline versus colloid solutions for induction of hypothermia: the effect of specific heat capacity on cooling.

    PubMed

    Idelchik, Gary M; Varon, Joseph

    2014-03-18

    The prevention of ischemic injury to preserve both end-organ function and improve neurological recovery by the implementation of therapeutic hypothermia has been well established in the literature. However, not only the means by which body temperature is cooled but also the rate by which target temperature is attained remains an area of continued interest and research. The induction of therapeutic hypothermia to begin the process of body temperature lowering through the infusion of a cold solution intravenously into the body may be one variable that influences not only rapidity of cooling but also subsequent clinical outcome. In a recent issue of Critical Care, Skulec and colleagues compared the induction of therapeutic hypothermia by cold normal saline versus cold colloid solution containing hydroxyethyl starch in a porcine animal model of cardiac arrest, assessing both the rate of temperature change and target temperature achieved, in addition to changes in intracranial pressure.

  20. Hypothermia

    MedlinePlus

    ... not possible, get the person out of the wind and use a blanket to provide insulation from ... protect your body. These include: Mittens (not gloves) Wind-proof, water-resistant, many-layered clothing Two pairs ...

  1. Rapid endovascular warming for profound hypothermia.

    PubMed

    Laniewicz, Megan; Lyn-Kew, Kenneth; Silbergleit, Robert

    2008-02-01

    Profound hypothermia is associated with high mortality and morbidity. Optimal outcomes have been reported with invasive extracorporeal warming techniques not readily available in most hospitals. Endovascular warming devices may provide a less invasive alternative. A 68-year-old woman developed profound hypothermia after environmental exposure. On arrival, she was comatose, severely bradycardic, without palpable pulses, and with a core body temperature of 23.0 degrees C (72 degrees F). Attempts to warm her with traditional methods during 2 hours were ineffective. An endovascular temperature control system was placed and effectively warmed the patient at about 3 degrees C (4.5 degrees F) per hour, with return of hemodynamic stability. When hypothermia is profound, surface warming works poorly and invasive strategies, including cardiopulmonary bypass, are recommended. Rapid warming from profound hypothermia can be accomplished with endovascular systems, and these may be an effective alternative to more invasive extracorporeal methods. PMID:17681640

  2. Prehospital ACLS--does it work?

    PubMed

    Maheshwari, Alok; Mehrotra, Avanti; Gupta, Anoop K; Thakur, Ranjan K

    2002-11-01

    Cardiac disease is the most common cause of death in the United States, and sudden cardiac arrest frequently claims the lives of men and women during their most productive years. It is believed that much better survival rates can be achieved for victims of cardiac arrest through optimizing the "chain of survival" as described by the American Heart Association. The relative and incremental benefit of full prehospital ACLS over basic life support and defibrillation is unproven, however. This is an important issue in this era of cost containment. Some of the ongoing studies including the OPALS study may clarify the cost effectiveness and relative efficacy of rapid defibrillation and full ACLS programs for victims of prehospital cardiac arrest [6].

  3. Prehospital airway management: A prospective case study.

    PubMed

    Wilbers, N E R; Hamaekers, A E W; Jansen, J; Wijering, S C; Thomas, O; Wilbers-van Rens, R; van Zundert, A A J

    2011-01-01

    We conducted a one-year prospective study involving a prehospital Emergency Medical Service in the Netherlands to investigate the incidence of failed or difficult prehospital endotracheal intubation. During the study period the paramedics were asked to fill in a registration questionnaire after every endotracheal intubation. Of the 26,271 patient contacts, 256 endotracheal intubations were performed by paramedics in one year. Endotracheal intubation failed in 12 patients (4.8%). In 12.0% of 249 patients, a Cormack and Lehane grade III laryngoscopy was reported and a grade IV laryngoscopy was reported in 10.4%. The average number of endotracheal intubations per paramedic in one year was 4.2 and varied from zero to a maximum of 12. The median time between arrival on the scene and a positive capnograph was 7 min.38 s in the case of a Cormack and Lehane grade I laryngoscopy and 14 min.58 s in the case of a Cormack and Lehane grade 4 laryngoscopy. The incidence of endotracheal intubations performed by Dutch paramedics in one year was low, but endotracheal intubation was successful in 95.2%, which is comparable with findings in international literature. Early capnography should be used consistently in prehospital airway management. PMID:21612142

  4. Portable arteriovenous rewarming for hypothermia: cardiovascular considerations.

    PubMed

    Fischer, Uwe M; Gill, Brijesh S; Aroom, Kevin; Fogle, Lindsey; Xue, Hasen; Cox, Charles S

    2008-01-01

    In trauma patients, continuous arteriovenous (AV) rewarming can effectively reverse hypothermia even if associated with hypovolemia. In battlefield conditions, however, portable fluid warmers driven by battery power show limited capacities. We studied the efficacy and safety of a portable fluid warmer that utilizes controlled hydrocarbon combustion (nonflame) for heat generation during continuous AV rewarming in a large animal model of hypothermia and hemorrhagic shock. Six dogs (26.1 +/- 0.8 kg) were cooled to a core temperature of 30 degrees C (hypo 1). After rewarming to 37 degrees C, dogs were bled by 20% of their estimated blood volume and cooled again to 30 degrees C (hypo 2) followed by rewarming. We recorded temperature (blood, esophageal, rectal, and bladder), left ventricular performance, hemodynamic parameters including superior mesenteric artery (SMA) flow and blood flow through the fluid warmer. Especially, we measured the effect of the AV-shunt on cardiac output and regional blood flow (superior mesenteric artery). Rewarming after hypothermia took 45 +/- 6 minutes (hypothermia 1) and 55 +/- 6 minutes (hypothermia 2), respectively. The AV-shunt flow was correlated to the cardiac output and affected neither cardiac output nor regional blood flow at any time point during the experiment. Arteriovenous rewarming, using the tested portable fluid warmer, effectively reversed hypothermia without compromising hemodynamics or regional blood flow. PMID:18496278

  5. Pre-hospital spinal immobilisation: an initial consensus statement.

    PubMed

    Connor, D; Greaves, I; Porter, K; Bloch, M

    2013-12-01

    This paper reviews the current evidence available on the practice of spinal immobilisation in the prehospital environment. Following this, initial conclusions from a consensus meeting held by the Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh in March 2012 are presented.

  6. In vitro arrhythmia generation by mild hypothermia: a pitchfork bifurcation type process.

    PubMed

    Xu, Binbin; Jacquir, Sabir; Laurent, Gabriel; Binczak, Stéphane; Pont, Oriol; Yahia, Hussein

    2015-03-01

    The neurological damage after cardiac arrest presents a huge challenge for hospital discharge. Therapeutic hypothermia (34 °C - 32 °C) has shown its benefits in reducing cerebral oxygen demand and improving neurological outcomes after cardiac arrest. However, it can have many adverse effects, among them cardiac arrhythmia generation which represents an important part (up to 34%, according different clinical studies). A monolayer cardiac culture is prepared with cardiomyocytes from a newborn rat, directly on a multi-electrode array, which allows the acquisition of the extracellular potential of the culture. The temperature range is 37 °C - 30 °C-37 °C, representing the cooling and rewarming process of therapeutic hypothermia. Experiments showed that at 35 °C, the acquired signals are characterized by period-doubling phenomenon, compared with signals at other temperatures. Spiral waves, commonly considered to be a sign of cardiac arrhythmia, are observed in the reconstructed activation map. With an approach from nonlinear dynamics, phase space reconstruction, it is shown that at 35 °C, the trajectories of these signals formed a spatial bifurcation, even trifurcation. Another transit point is found between 30 °C-33 °C, which agreed with other clinical studies that induced hypothermia after cardiac arrest should not fall below 32 °C. The process of therapeutic hypothermia after cardiac arrest can be represented by a pitchfork bifurcation type process, which could explain the different ratios of arrhythmia among the adverse effects after this therapy. This nonlinear dynamic suggests that a variable speed of cooling/rewarming, especially when passing 35 °C, would help to decrease the ratio of post-hypothermia arrhythmia and then improve the hospital output. PMID:25690526

  7. In vitro arrhythmia generation by mild hypothermia: a pitchfork bifurcation type process.

    PubMed

    Xu, Binbin; Jacquir, Sabir; Laurent, Gabriel; Binczak, Stéphane; Pont, Oriol; Yahia, Hussein

    2015-03-01

    The neurological damage after cardiac arrest presents a huge challenge for hospital discharge. Therapeutic hypothermia (34 °C - 32 °C) has shown its benefits in reducing cerebral oxygen demand and improving neurological outcomes after cardiac arrest. However, it can have many adverse effects, among them cardiac arrhythmia generation which represents an important part (up to 34%, according different clinical studies). A monolayer cardiac culture is prepared with cardiomyocytes from a newborn rat, directly on a multi-electrode array, which allows the acquisition of the extracellular potential of the culture. The temperature range is 37 °C - 30 °C-37 °C, representing the cooling and rewarming process of therapeutic hypothermia. Experiments showed that at 35 °C, the acquired signals are characterized by period-doubling phenomenon, compared with signals at other temperatures. Spiral waves, commonly considered to be a sign of cardiac arrhythmia, are observed in the reconstructed activation map. With an approach from nonlinear dynamics, phase space reconstruction, it is shown that at 35 °C, the trajectories of these signals formed a spatial bifurcation, even trifurcation. Another transit point is found between 30 °C-33 °C, which agreed with other clinical studies that induced hypothermia after cardiac arrest should not fall below 32 °C. The process of therapeutic hypothermia after cardiac arrest can be represented by a pitchfork bifurcation type process, which could explain the different ratios of arrhythmia among the adverse effects after this therapy. This nonlinear dynamic suggests that a variable speed of cooling/rewarming, especially when passing 35 °C, would help to decrease the ratio of post-hypothermia arrhythmia and then improve the hospital output.

  8. "Paradoxical undressing" in fatal hypothermia.

    PubMed

    Wedin, B; Vanggaard, L; Hirvonen, J

    1979-07-01

    The phenomenon called paradoxical undressing has been described from 33 cases of hypothermia collected from Swedish police reports. The cases were almost evenly distributed with regard to sex, age, and geographical distribution. The cases occurred more frequently in open land although cases from town areas were also found. Most incidents were recorded from November to February at low ambient temperatures, although cases were also reported at temperatures above 0 degree C. Arteriosclerosis and chronic alcoholism were important concomitant illnesses, the latter being frequent in middle-aged men. Epilepsy, diabetes, and pregnancy were present in single cases. Ethanol and other drugs were present in 67% of the males and in 78% of the females, ethanol predominating in men and various psychotropic agents in women. The mean blood ethanol concentration in males was 0.16% and in females, 0.18%. Most frequent findings at necropsy were purple spots or discoloration on the extremities, pulmonary edema, and gastric hemorrhages. It is concluded that paradoxical undressing might be explained by changes in peripheral vasoconstriction in the deeply hypothermic person. It represents the last effort of the victim and is followed almost immediately by unconsciousness and death. PMID:541627

  9. Pharmacologically induced hypothermia attenuates traumatic brain injury in neonatal rats.

    PubMed

    Gu, Xiaohuan; Wei, Zheng Zachory; Espinera, Alyssa; Lee, Jin Hwan; Ji, Xiaoya; Wei, Ling; Dix, Thomas A; Yu, Shan Ping

    2015-05-01

    Neonatal brain trauma is linked to higher risks of mortality and neurological disability. The use of mild to moderate hypothermia has shown promising potential against brain injuries induced by stroke and traumatic brain injury (TBI) in various experimental models and in clinical trials. Conventional methods of physical cooling, however, are difficult to use in acute treatments and in induction of regulated hypothermia. In addition, general anesthesia is usually required to mitigate the negative effects of shivering during physical cooling. Our recent investigations demonstrate the potential therapeutic benefits of pharmacologically induced hypothermia (PIH) using the neurotensin receptor (NTR) agonist HPI201 (formerly known as ABS201) in stroke and TBI models of adult rodents. The present investigation explored the brain protective effects of HPI201 in a P14 rat pediatric model of TBI induced by controlled cortical impact. When administered via intraperitoneal (i.p.) injection, HPI201 induced dose-dependent reduction of body and brain temperature. A 6-h hypothermic treatment, providing an overall 2-3°C reduction of brain and body temperature, showed significant effect of attenuating the contusion volume versus TBI controls. Attenuation occurs whether hypothermia is initiated 15min or 2h after TBI. No shivering response was seen in HPI201-treated animals. HPI201 treatment also reduced TUNEL-positive and TUNEL/NeuN-colabeled cells in the contusion area and peri-injury regions. TBI-induced blood-brain barrier damage was attenuated by HPI201 treatment, evaluated using the Evans Blue assay. HPI201 significantly decreased MMP-9 levels and caspase-3 activation, both of which are pro-apototic, while it increased anti-apoptotic Bcl-2 gene expression in the peri-contusion region. In addition, HPI201 prevented the up-regulation of pro-inflammatory tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and IL-6. In sensorimotor activity assessments, rats in the HPI201

  10. Pharmacologically Induced Hypothermia Attenuates Traumatic Brain Injury in Neonatal Rats

    PubMed Central

    Espinera, Alyssa; Lee, Jin Hwan; Ji, Xiaoya; Wei, Ling; Dix, Thomas A.; Yu, Shan Ping

    2015-01-01

    Neonatal brain trauma is linked to higher risks of mortality and neurological disability. The use of mild to moderate hypothermia has shown promising potential against brain injuries induced by stroke and traumatic brain injury (TBI) in various experimental models and in clinical trials. Conventional methods of physical cooling, however, are difficult to use in acute treatments and in induction of regulated hypothermia. In addition, general anesthesia is usually required to mitigate the negative effects of shivering during physical cooling. Our recent investigations demonstrate the potential therapeutic benefits of pharmacologically induced hypothermia (PIH) using the neurotensin receptor (NTR) agonist HPI201 (formerly known as ABS201) in stroke and TBI models of adult rodents. The present investigation explored the brain protective effects of HPI201 in a P14 rat pediatric model of TBI induced by controlled cortical impact. When administered via intraperitoneal (i.p.) injection, HPI201 induced dose-dependent reduction of body and brain temperature. A six-hour hypothermic treatment, providing an overall 2-3°C reduction of brain and body temperature, showed significant effect of attenuating the contusion volume versus TBI controls. Attenuation occurs whether hypothermia is initiated 15 min or 2 hr after TBI. No shivering response was seen in HPI201-treated animals. HPI201 treatment also reduced TUNEL-positive and TUNEL/NeuN-colabeled cells in the contusion area and peri-injury regions. TBI-induced blood brain barrier damage was attenuated by HPI201 treatment, evaluated using the Evans Blue assay. HPI201 significantly decreased MMP-9 levels and Caspase-3 activation, both of which are pro-apototic, while it increased anti-apoptotic Bcl-2 gene expression in the peri-contusion region. In addition, HPI201 prevented the up-regulation of pro-inflammatory tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and IL-6. In sensorimotor activity assessments, rats in the

  11. Safety and Efficacy of Prehospital Diltiazem

    PubMed Central

    Luk, Jeffrey H.; Walsh, Brian; Yasbin, Paul

    2013-01-01

    Introduction: Very few studies exist on the use of diltiazem in the prehospital setting. Some practitioners believe this medication is prone to causing hypotension in this setting. Our goals were to determine whether the prehospital administration of diltiazem induced hypotension and to evaluate the efficacy of the drug. Methods: Our two-tiered system is located in a suburban region of New Jersey with advanced life support (ALS) care provided by fly-car units. The ALS units do not transport patients, and all of them are hospital based. The ALS providers are employed by the hospital system. In New Jersey, all ALS care requires online medical control, including the administration of diltiazem. We retrospectively reviewed patient care records for those who were believed to be in rapid atrial fibrillation and were given diltiazem in a suburban emergeny medical services system over a 22-month period. We examined the differences between heart rate (HR) and blood pressure (BP) on the initial evaluation and on arrival to the emergency department (ED). A hypotensive response was defined as a final systolic BP (SBP) less than 90 mmHg and a drop in SBP of at least 10 mmHg. Diltiazem was considered effective if the ED HR was <100 beats per minute (bpm) or if it decreased ≥20%. Results: During the study period, 26,979 patients were transported. Of these patients, 2,488 had a documented rhythm of atrial fibrillation or atrial flutter. Of the 320 patients who received diltiazem, 42 patient encounters were excluded for incomplete data, yielding 278 patients for analysis. The average initial SBP was 139 mmHg and the average diastolic BP was 84 mmHg. The average diltiazem dosage was 16.7 mg. Two patients became hypotensive. The average initial HR was 154 bpm. On arrival to the ED, 33% of the patients had an HR < 100 bpm and 69% had a drop in HR ≥ 20%. The overall efficacy of prehospital diltiazem was 73%. Conclusion: In the prehospital setting, diltiazem is associated with a

  12. [Hypothermia in the elderly: a shivering case].

    PubMed

    Merlino, Aldo; Iudicello, Mario Soccorso; Vasquez, Ludovico; Pizzimenti, Giovanni; Badessa, Francesco; Grasso, Paolo

    2007-04-01

    Hypothermia is a medical emergency in patients with a body temperature lower than 35 degrees C (95 degrees F) due to prolonged exposure to ambient cold temperatures without appropriate protection. This condition has a 5-fold increased risk of death in the elderly. Usually, diagnosis is suggested by warning signs and symptoms like lethargy, weakness and loss of coordination, confusion and reduced respiratory or heart rate. We report the case of a 76-year-old woman who was referred to our center for symptomatic sinus bradycardia and with typical electrocardiographic abnormalities (Osborn wave) that suggested the diagnosis of severe hypothermia. PMID:17506298

  13. Hypothermia improves outcome from cardiac arrest.

    PubMed

    Bernard, S A

    2005-12-01

    Out-of-hospital cardiac arrest is common and patients who are initially resuscitated by ambulance officers and transported to hospital are usually admitted to the intensive care unit (ICU). In the past, the treatment in the ICU consisted of supportive care only, and most patients remained unconscious due to the severe anoxic neurological injury. It was this neurological injury rather than cardiac complications that caused the high rate of morbidity and mortality. However, in the early 1990's, a series of animal experiments demonstrated convincingly that mild hypothermia induced after return of spontaneous circulation and maintained for several hours dramatically reduced the severity of the anoxic neurological injury. In the mid-1990's, preliminary human studies suggested that mild hypothermia could be induced and maintained in post-cardiac arrest patients without an increase in the rate of cardiac or other complications. In the late 1990's, two prospective, randomised, controlled trials were conducted and the results confirmed the animal data that mild hypothermia induced after resuscitation and maintained for 12 - 24 hours dramatically improved neurological and overall outcomes. On the basis of these studies, mild hypothermia was endorsed in 2003 by the International Liaison Committee on Resuscitation as a recommended treatment for comatose patients with an initial cardiac rhythm of ventricular fibrillation. However, the application of this therapy into routine clinical critical care practice has been slow. The reasons for this are uncertain, but may relate to the relative complexity of the treatment, unfamiliarity with the pathophysiology of hypothermia, lack of clear protocols and/or uncertainty of benefit in particular patients. Therefore, recent research in this area has focused on the development of feasible, inexpensive techniques for the early, rapid induction of mild hypothermia after cardiac arrest. Currently, the most promising strategy is a rapid

  14. Paroxysmal hypertension and spontaneous periodic hypothermia.

    PubMed

    De Plaen, J L; Sepulchre, D; Bidingija, M

    1992-01-01

    We report the case of a 42-year-old Zairian male who presented with paroxysmal attacks of hypertension accompanied by spontaneous recurrent hypothermia and profuse sweating of unknown origin. Routine and extensive examination failed to indicate a usual cause of arterial hypertension or for periodic hypothermia. Based on the hypothesis of an epileptic center influencing both the thermoregulatory and the vasomotor mechanisms, an anticonvulsant treatment was successfully installed. The present study makes a correlation between the present condition and certain neurologic abnormalities described in the literature. PMID:1337813

  15. Systemic Administration of the TRPV3 Ion Channel Agonist Carvacrol Induces Hypothermia in Conscious Rodents

    PubMed Central

    Feketa, Viktor V.; Marrelli, Sean P.

    2015-01-01

    Therapeutic hypothermia is a promising new strategy for neuroprotection. However, the methods for safe and effective hypothermia induction in conscious patients are lacking. The current study explored the Transient Receptor Potential Vanilloid 3 (TRPV3) channel activation by the agonist carvacrol as a potential hypothermic strategy. It was found that carvacrol lowers core temperature after intraperitoneal and intravenous administration in mice and rats. However, the hypothermic effect at safe doses was modest, while higher intravenous doses of carvacrol induced a pronounced drop in blood pressure and substantial toxicity. Experiments on the mechanism of the hypothermic effect in mice revealed that it was associated with a decrease in whole-body heat generation, but not with a change in cold-seeking behaviors. In addition, the hypothermic effect was lost at cold ambient temperature. Our findings suggest that although TRPV3 agonism induces hypothermia in rodents, it may have a limited potential as a novel pharmacological method for induction of hypothermia in conscious patients due to suboptimal effectiveness and high toxicity. PMID:26528923

  16. Utilization of Hyperbaric Oxygen Therapy and Induced Hypothermia After Hydrogen Sulfide Exposure

    PubMed Central

    Asif, Mir J.; Exline, Matthew C.

    2013-01-01

    Hydrogen sulfide is a toxic gas produced as a byproduct of organic waste and many industrial processes. Hydrogen sulfide exposure symptoms may vary from mild (dizziness, headaches, nausea) to severe lactic acidosis via its inhibition of oxidative phosphorylation, leading to cardiac arrhythmias and death. Treatment is generally supportive. We report the case of a patient presenting with cardiac arrest secondary to hydrogen sulfide exposure treated with both hyperbaric oxygen therapy and therapeutic hypothermia with great improvement in neurologic function. PMID:22004989

  17. Hypothermia-related deaths--United States, 2003.

    PubMed

    2004-03-01

    Hypothermia, a preventable lowering of the core body temperature to <95 degrees F (<35 degrees C), causes approximately 600 deaths each year in the United States. Exposure to excessive cold (or excessive exposure to cold) slows enzymatic activity throughout the body, leading to potentially fatal rhabdomyolysis, coagulopathy, renal failure, and dysrhythmias. Alcohol intake, activity level, and type of clothing are among the modifiable factors associated with hypothermia. Understanding the epidemiology and pathophysiology of hypothermia is important to preventing hypothermia-related mortality. This report describes three cases of fatal hypothermia that occurred during 2003, reviews national statistics on mortality from cold exposure in 2001, and provides recommendations for the diagnosis, treatment, and prevention of hypothermia. Public health strategies tailored to U.S. populations at increased risk for exposure to excessive cold can help reduce mortality and morbidity from hypothermia. PMID:15001877

  18. Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia.

    PubMed

    Zafren, Ken; Giesbrecht, Gordon G; Danzl, Daniel F; Brugger, Hermann; Sagalyn, Emily B; Walpoth, Beat; Weiss, Eric A; Auerbach, Paul S; McIntosh, Scott E; Némethy, Mária; McDevitt, Marion; Dow, Jennifer; Schoene, Robert B; Rodway, George W; Hackett, Peter H; Bennett, Brad L; Grissom, Colin K

    2014-12-01

    To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations.

  19. Hypothermia and the Elderly: Perceptions and Behaviors.

    ERIC Educational Resources Information Center

    Avery, Carol E.; Pestle, Ruth E.

    1987-01-01

    Interviewed 381 older adults participating in Area Agency on Aging meal programs in Florida. Found that only 10 percent were aware of dangers of accidental hypothermia. Many low-income elderly are vulnerable to cold because of poorly insulated homes, inadequate heating, and lack of warm clothing. States need initiatives to increase comfort levels…

  20. Hypothermia following Pediatric Traumatic Brain Injury

    PubMed Central

    2009-01-01

    Abstract Preclinical as well as clinical studies in traumatic brain injury (TBI) have established the likely association of secondary injury and outcome in adults in children following severe injury. Similarly, there is growing evidence in experimental laboratory studies that moderate hypothermia has a beneficial effect on outcome, though the exact mechanisms remain to be absolutely defined. The Pediatric TBI Guidelines provided the knowledge and background for standard management of children following severe TBI and highlighted that there are very few clinical studies to date. In particular with respect to temperature regulation and the use of hypothermia, initial findings of case series of small numbers were promising. Further preliminary randomized clinical trials, both single institution and multicenter, have provided the initial data on safety and efficacy, though larger, Phase III studies are necessary to ensure both the safety and efficacy of hypothermia in pediatric TBI prior to implementation as part of the standard of care. It is expected that hypothermia initiated early after severe TBI will have a protective effect on the pediatric brain and can be done safely, but this still remains to be definitively tested. PMID:19271965

  1. [Hypothermia in people in situations of precarity].

    PubMed

    Bernard, Serge

    2011-05-01

    Human beings are physiologically warm blooded. Confronted with extreme cold, they become subject to hypothermia. Between a mountain climber and a person living in the street, the functions of resistance to a drop in external temperature are not the same. Studies on this subject remain to be carried out. PMID:21717680

  2. Neonatal hypothermia in low-resource settings

    PubMed Central

    Mullany, LC

    2010-01-01

    Hypothermia among newborns is considered an important contributor to neonatal morbidity and mortality in low resource settings. However, in these settings only limited progress has been made towards understanding the risk of mortality subsequent to hypothermia, describing how this relationship is dependent on both the degree or severity of exposure and the gestational age and weight status of the baby, and implementing interventions to mitigate both exposure and the associated risk of poor outcomes. Given the centrality of averting neonatal mortality to achieving global milestones towards reductions in child mortality by 2015, recent years have seen substantial resources and efforts to improve understanding of global epidemiology of neonatal health. In this seminar, a summary of the burden, consequences, and risk factors of neonatal hypothermia in low-resources settings is presented, with a particular focus on community-based data. Context-appropriate interventions for reducing hypothermia exposure and the role of these interventions in reducing global neonatal mortality burden are explored. PMID:21094417

  3. Angiogenesis Dysregulation in Term Asphyxiated Newborns Treated with Hypothermia

    PubMed Central

    Shaikh, Henna; Boudes, Elodie; Khoja, Zehra; Shevell, Michael; Wintermark, Pia

    2015-01-01

    Background Neonatal encephalopathy following birth asphyxia is a major predictor of long-term neurological impairment. Therapeutic hypothermia is currently the standard of care to prevent brain injury in asphyxiated newborns but is not protective in all cases. More robust and versatile treatment options are needed. Angiogenesis is a demonstrated therapeutic target in adult stroke. However, no systematic study examines the expression of angiogenesis-related markers following birth asphyxia in human newborns. Objective This study aimed to evaluate the expression of angiogenesis-related protein markers in asphyxiated newborns developing and not developing brain injury compared to healthy control newborns. Design/Methods Twelve asphyxiated newborns treated with hypothermia were prospectively enrolled; six developed eventual brain injury and six did not. Four healthy control newborns were also included. We used Rules-Based Medicine multi-analyte profiling and protein array technologies to study the plasma concentration of 49 angiogenesis-related proteins. Mean protein concentrations were compared between each group of newborns. Results Compared to healthy newborns, asphyxiated newborns not developing brain injury showed up-regulation of pro-angiogenic proteins, including fatty acid binding protein-4, glucose-6-phosphate isomerase, neuropilin-1, and receptor tyrosine-protein kinase erbB-3; this up-regulation was not evident in asphyxiated newborns eventually developing brain injury. Also, asphyxiated newborns developing brain injury showed a decreased expression of anti-angiogenic proteins, including insulin-growth factor binding proteins -1, -4, and -6, compared to healthy newborns. Conclusions These findings suggest that angiogenesis pathways are dysregulated following birth asphyxia and are putatively involved in brain injury pathology and recovery. PMID:25996847

  4. Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update.

    PubMed

    Zafren, Ken; Giesbrecht, Gordon G; Danzl, Daniel F; Brugger, Hermann; Sagalyn, Emily B; Walpoth, Beat; Weiss, Eric A; Auerbach, Paul S; McIntosh, Scott E; Némethy, Mária; McDevitt, Marion; Dow, Jennifer; Schoene, Robert B; Rodway, George W; Hackett, Peter H; Bennett, Brad L; Grissom, Colin K

    2014-12-01

    To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia published in Wilderness & Environmental Medicine 2014;25(4):425-445.

  5. Neuroprotective effects of bloodletting at Jing points combined with mild induced hypothermia in acute severe traumatic brain injury

    PubMed Central

    Tu, Yue; Miao, Xiao-mei; Yi, Tai-long; Chen, Xu-yi; Sun, Hong-tao; Cheng, Shi-xiang; Zhang, Sai

    2016-01-01

    Bloodletting at Jing points has been used to treat coma in traditional Chinese medicine. Mild induced hypothermia has also been shown to have neuroprotective effects. However, the therapeutic effects of bloodletting at Jing points and mild induced hypothermia alone are limited. Therefore, we investigated whether combined treatment might have clinical effectiveness for the treatment of acute severe traumatic brain injury. Using a rat model of traumatic brain injury, combined treatment substantially alleviated cerebral edema and blood-brain barrier dysfunction. Furthermore, neurological function was ameliorated, and cellular necrosis and the inflammatory response were lessened. These findings suggest that the combined effects of bloodletting at Jing points (20 μL, twice a day, for 2 days) and mild induced hypothermia (6 hours) are better than their individual effects alone. Their combined application may have marked neuroprotective effects in the clinical treatment of acute severe traumatic brain injury. PMID:27482221

  6. Pre-Hospital Emergency in Iran: A Systematic Review

    PubMed Central

    Bahadori, Mohammadkarim; Ghardashi, Fatemeh; Izadi, Ahmad Reza; Ravangard, Ramin; Mirhashemi, Sedigheh; Hosseini, Seyed Mojtaba

    2016-01-01

    Context Pre-hospital care plays a vital role in saving trauma patients. Objectives This study aims to review studies conducted on the pre-hospital emergency status in Iran. Data Sources Data were sourced from Iranian electronic databases, including SID, IranMedex, IranDoc, Magiran, and non-Iranian electronic databases, such as Medline, Embase, Cochrane Library, Scopus, and Google Scholar. In addition, available data and statistics for the country were used. Data Selection All Persian-language articles published in Iranian scientific journals and related English-language articles published in Iranian and non-Iranian journals indexed on valid sites for September 2005 - 2014 were systematically reviewed. Data Extraction To review the selected articles, a data extraction form developed by the researchers as per the study’s objective was adopted. The articles were examined under two categories: structure and function of pre-hospital emergency. Results A total of 19 articles were selected, including six descriptive studies (42%), four descriptive-analytical studies (21%), five review articles (16%), two qualitative studies (10.5%), and two interventional (experimental) studies (10.5%). In addition, of these, 14 articles (73.5%) had been published in the English language. The focus of these selected articles were experts (31.5%), bases of emergency medical services (26%), injured (16%), data reviews (16%), and employees (10.5%). A majority of the studies (68%) investigated pre-hospital emergency functions and 32% reviewed the pre-hospital emergency structure. Conclusions The number of studies conducted on pre-hospital emergency services in Iran is limited. To promote public health, consideration of prevention areas, processes to provide pre-hospital emergency services, policymaking, foresight, systemic view, comprehensive research programs and roadmaps, and assessments of research needs in pre-hospital emergency seem necessary. PMID:27626016

  7. Hypothermia augments neuroprotective activity of mesenchymal stem cells for neonatal hypoxic-ischemic encephalopathy.

    PubMed

    Park, Won Soon; Sung, Se In; Ahn, So Yoon; Yoo, Hye Soo; Sung, Dong Kyung; Im, Geun Ho; Choi, Soo Jin; Chang, Yun Sil

    2015-01-01

    Though hypothermia is the only clinically available treatment for neonatal hypoxic-ischemic encephalopathy (HIE), it is not completely effective in severe cases. We hypothesized that combined treatment with hypothermia and transplantation of human umbilical cord blood (UCB)-derived mesenchymal stem cells (MSCs) would synergistically attenuate severe HIE compared to stand-alone therapy. To induce hypoxia-ischemia (HI), male Sprague-Dawley rats were subjected to 8% oxygen for 120 min after unilateral carotid artery ligation on postnatal day (P) 7. After confirmation of severe HIE involving >50% of the ipsilateral hemisphere volume as determined by diffusion-weighted brain magnetic resonance imaging (MRI) within 2 h after HI, intraventricular MSC transplantation (1 × 105 cells) and/or hypothermia with target temperature at 32°C for 24 h were administered 6 h after induction of HI. Follow-up brain MRI at P12 and P42, sensorimotor function tests at P40-42, evaluation of cytokines in the cerebrospinal fluid (CSF) at P42, and histologic analysis of peri-infarct tissues at P42 were performed. Severe HI resulted in progressively increased brain infarction over time as assessed by serial MRI, increased number of cells positive for terminal deoxynucleotidyl transferase nick-end labeling, microgliosis and astrocytosis, increased CSF cytokine levels, and impaired function in behavioral tests such as rotarod and cylinder tests. All of the abnormalities observed in severe HIE showed greater improvement after combined treatment with hypothermia and MSC transplantation than with either therapy alone. Overall, these findings suggest that combined treatment with hypothermia and human UCB-derived MSC transplantation might be a novel therapeutic modality to improve the prognosis of severe HIE, an intractable disease that currently has no effective treatment.

  8. Hypothermia augments neuroprotective activity of mesenchymal stem cells for neonatal hypoxic-ischemic encephalopathy.

    PubMed

    Park, Won Soon; Sung, Se In; Ahn, So Yoon; Yoo, Hye Soo; Sung, Dong Kyung; Im, Geun Ho; Choi, Soo Jin; Chang, Yun Sil

    2015-01-01

    Though hypothermia is the only clinically available treatment for neonatal hypoxic-ischemic encephalopathy (HIE), it is not completely effective in severe cases. We hypothesized that combined treatment with hypothermia and transplantation of human umbilical cord blood (UCB)-derived mesenchymal stem cells (MSCs) would synergistically attenuate severe HIE compared to stand-alone therapy. To induce hypoxia-ischemia (HI), male Sprague-Dawley rats were subjected to 8% oxygen for 120 min after unilateral carotid artery ligation on postnatal day (P) 7. After confirmation of severe HIE involving >50% of the ipsilateral hemisphere volume as determined by diffusion-weighted brain magnetic resonance imaging (MRI) within 2 h after HI, intraventricular MSC transplantation (1 × 105 cells) and/or hypothermia with target temperature at 32°C for 24 h were administered 6 h after induction of HI. Follow-up brain MRI at P12 and P42, sensorimotor function tests at P40-42, evaluation of cytokines in the cerebrospinal fluid (CSF) at P42, and histologic analysis of peri-infarct tissues at P42 were performed. Severe HI resulted in progressively increased brain infarction over time as assessed by serial MRI, increased number of cells positive for terminal deoxynucleotidyl transferase nick-end labeling, microgliosis and astrocytosis, increased CSF cytokine levels, and impaired function in behavioral tests such as rotarod and cylinder tests. All of the abnormalities observed in severe HIE showed greater improvement after combined treatment with hypothermia and MSC transplantation than with either therapy alone. Overall, these findings suggest that combined treatment with hypothermia and human UCB-derived MSC transplantation might be a novel therapeutic modality to improve the prognosis of severe HIE, an intractable disease that currently has no effective treatment. PMID:25816095

  9. Current pre-hospital traumatic brain injury management in China

    PubMed Central

    Kou, Kou; Hou, Xiang-yu; Sun, Jian-dong; Chu, Kevin

    2014-01-01

    BACKGROUND: Traumatic brain injury (TBI) is associated with most trauma-related deaths. Secondary brain injury is the leading cause of in-hospital deaths after traumatic brain injury. By early prevention and slowing of the initial pathophysiological mechanism of secondary brain injury, pre-hospital service can significantly reduce case-fatality rates of TBI. In China, the incidence of TBI is increasing and the proportion of severe TBI is much higher than that in other countries. The objective of this paper is to review the pre-hospital management of TBI in China. DATA SOURCES: A literature search was conducted in January 2014 using the China National Knowledge Infrastructure (CNKI). Articles on the assessment and treatment of TBI in pre-hospital settings practiced by Chinese doctors were identified. The information on the assessment and treatment of hypoxemia, hypotension, and brain herniation was extracted from the identified articles. RESULTS: Of the 471 articles identified, 65 met the selection criteria. The existing literature indicated that current practices of pre-hospital TBI management in China were sub-optimal and varied considerably across different regions. CONCLUSION: Since pre-hospital care is the weakest part of Chinese emergency care, appropriate training programs on pre-hospital TBI management are urgently needed in China. PMID:25548596

  10. Chapter 9 prehospital tourniquets: review, recommendations, and future research.

    PubMed

    Lewis, Paul C

    2014-01-01

    The tourniquet is a simple device that has been used since the Middle Ages. Although different variations have been designed throughout its history, the simplicity of design has remained. The history of tourniquets follows two distinct paths--the operating room and the prehospital setting. From the earliest recorded history, tourniquets have been used for surgical procedures which were originally to amputate war-ravaged limbs and then to create a bloodless field for routine limb surgery. This history has continued uninterrupted since the early 1900s with continued research to foster advances in knowledge. The history of tourniquets in the prehospital setting, however, has not progressed as smoothly. The debate regarding the use of a tourniquet to save a life from excessive limb hemorrhage began in the 1600s, and continues to this day. This chapter will explore the prehospital use of tourniquets, which may shed some light on where this debate originated. The current state of the knowledge regarding tourniquets will then be discussed with a focus on prehospital use, using the operating room literature when needed to fill knowledge gaps. The chapter will conclude with recommendations for prehospital tourniquet use and some areas for future research. Tourniquets are used for operative procedures within accepted clinical guidelines throughout the world as the standard of care. Current science supports a similar stance for the use of prehospital tourniquets within clinical guidelines.

  11. Chapter 9 prehospital tourniquets: review, recommendations, and future research.

    PubMed

    Lewis, Paul C

    2014-01-01

    The tourniquet is a simple device that has been used since the Middle Ages. Although different variations have been designed throughout its history, the simplicity of design has remained. The history of tourniquets follows two distinct paths--the operating room and the prehospital setting. From the earliest recorded history, tourniquets have been used for surgical procedures which were originally to amputate war-ravaged limbs and then to create a bloodless field for routine limb surgery. This history has continued uninterrupted since the early 1900s with continued research to foster advances in knowledge. The history of tourniquets in the prehospital setting, however, has not progressed as smoothly. The debate regarding the use of a tourniquet to save a life from excessive limb hemorrhage began in the 1600s, and continues to this day. This chapter will explore the prehospital use of tourniquets, which may shed some light on where this debate originated. The current state of the knowledge regarding tourniquets will then be discussed with a focus on prehospital use, using the operating room literature when needed to fill knowledge gaps. The chapter will conclude with recommendations for prehospital tourniquet use and some areas for future research. Tourniquets are used for operative procedures within accepted clinical guidelines throughout the world as the standard of care. Current science supports a similar stance for the use of prehospital tourniquets within clinical guidelines. PMID:25222543

  12. Therapeutic hypothermia and frostbite injury: a preventable source.

    PubMed

    Lohana, Parkash; Hart, Andrew

    2011-05-01

    Frostbite injury from cold exposure is not uncommon. The application of ice pack is well known in clinical practice; however, its improper use can pose danger to the patient. We report a case of frostbite injury due to prolonged use of ice packs in a ventilated patient. PMID:21680308

  13. [Hypothermia as a treatment for hypoxic ischemic encephalopathy after neonatal asphyxia--update].

    PubMed

    Kessel, Irena; Waisman, Dan; Barzilai, Menashe; Soloveichick, Marina; Rotschild, Avi

    2013-09-01

    Hypoxic-ischemic encephalopathy (HIE) due to neonatal asphyxia is an important cause of irreversible bad neurodevelopmental outcomes in children. Understanding the mechanisms causing the central nervous system cell death enabled the development of new treatment strategies that may decrease the severity of neurological damage. This survey includes data on epidemiology, pathogenesis, clinical features and diagnostic criteria of HIE. We discuss the neuro-protective mechanisms of therapeutic hypothermia and provide data on clinical studies conducted to investigate the impact and safety of this treatment in newborn infants affected by HIE. In addition, other therapeutic options of neuro-protective agents are mentioned.

  14. [Management of peri-operative hypothermia].

    PubMed

    Fernández-Meré, L A; Alvarez-Blanco, M

    2012-01-01

    Hypothermia (body temperature under 36°C) is the thermal disorder most frequently found in surgical patients, but should be avoided as a means of reducing morbidity and costs. Temperature should be considered as a vital sign and all staff involved in the care of surgical patients must be aware that it has to be maintained within normal limits. Maintaining body temperature is the result, as in any other system, of the balance between heat production and heat loss. Temperature regulation takes place through a system of positive and negative feedback in the central nervous system, being developed in three phases: thermal afferent, central regulation and efferent response. Prevention is the best way to ensure a normal temperature. The active warming of the patient during surgery is mandatory. Using warm air is the most effective, simple and cheap way to prevent and treat hypothermia. PMID:22789615

  15. Episodic spontaneous hypothermia: a periodic childhood syndrome.

    PubMed

    Ruiz, Cynthia; Gener, Blanca; Garaizar, Carmen; Prats, José M

    2003-04-01

    Episodic spontaneous hypothermia is an infrequent disorder, with unknown pathogenic mechanisms. A systemic cause or underlying brain lesion has not been found for the disease. We report four new patients, 3-9 years old, with episodic hypothermia lower than 35 degrees C, marked facial pallor, and absent shivering. The episodes could last a few hours or four days, and recurred once a week or every 2-3 months. Two patients also demonstrated bradycardia, mild hypertension, and somnolence during the events; in one of them, profuse sweating was also a feature, and all four presented with either headache, a periodic childhood syndrome, or both (recurrent abdominal pain, cyclic vomiting, or vertigo). Three patients reported a family history of migraine. Neurologic examination, endocrine function, and imaging studies were normal. Migraine prophylactic therapy was of moderate efficacy. Spontaneous resolution was observed in one patient. The clinical characteristics of the syndrome allow for its inclusion as a childhood periodic syndrome related to migraine. PMID:12849886

  16. Hypothermia for Hypoxic Ischemic Encephalopathy in Infants ≥ 36 weeks

    PubMed Central

    Higgins, Rosemary D.; Shankaran, Seetha

    2009-01-01

    Hypoxic ischemic encephalopathy is a serious condition affecting infants which can result in death and disability. This is a summary of pathogenesis of HIE, animal studies of cooling for hypoxic and ischemic models, human hypothermia trials, and the American Academy of Pediatrics publication on hypothermia for HIE. Hypothermia for neonatal HIE is continuing to evolve as a therapy. Studies, gaps in knowledge and opportunities for research are presented herein. PMID:19762176

  17. Heat Capacity, Body Temperature, and Hypothermia

    NASA Astrophysics Data System (ADS)

    Kimbrough, Doris R.

    1998-01-01

    Even when air and water are at the same temperature, water will "feel" distinctly colder to us. This difference is due to the much higher heat capacity of water than of air. Offered here is an interesting life science application of water's high heat capacity and its serious implications for the maintenance of body temperature and the prevention of hypothermia in warm-blooded animals.

  18. Innate hypothermia after hypoxic ischaemic delivery.

    PubMed

    Jayasinghe, Dulip

    2015-01-01

    The focus of this review is to collate the literature on the phenomenon of impaired thermal adaptation after hypoxic ischaemic (HI) delivery often culminating in hypothermia. This phenomenon appears different in severity and duration to a spontaneous postnatal fall in temperature observed after normal delivery. The original observation and contemporary descriptions of the temperature response to HI are described and a mechanism of action is proposed that may be utilised as a novel biomarker for HI. PMID:25675993

  19. The small chill: mild hypothermia for cardioprotection?

    PubMed

    Tissier, Renaud; Chenoune, Mourad; Ghaleh, Bijan; Cohen, Michael V; Downey, James M; Berdeaux, Alain

    2010-12-01

    Reducing the heart's temperature by 2-5°C is a potent cardioprotective treatment in animal models of coronary artery occlusion. The anti-infarct benefit depends upon the target temperature and the time at which cooling is instituted. Protection primarily results from cooling during the ischaemic period, whereas cooling during reperfusion or beyond offers little protection. In animal studies, protection is proportional to both the depth and duration of cooling. An optimal cooling protocol must appreciably shorten the normothermic ischaemic time to effectively salvage myocardium. Patients presenting with acute myocardial infarction could be candidates for mild hypothermia since the current door-to-balloon time is typically 90 min. But they would have to be cooled quickly shortly after their arrival. Several strategies have been proposed for ultra-fast cooling, but most like liquid ventilation and pericardial perfusion are too invasive. More feasible strategies might include cutaneous cooling, peritoneal lavage with cold solutions, and endovascular cooling with intravenous thermodes. This last option has been investigated clinically, but the results have been disappointing possibly because the devices lacked capacity to cool the patient quickly or cooling was not implemented soon enough. The mechanism of hypothermia's protection has been assumed to be energy conservation. However, whereas deep hypothermia clearly preserves ATP, mild hypothermia has only a modest effect on ATP depletion during ischaemia. Some evidence suggests that intracellular signalling pathways might be responsible for the protection. It is unknown how cooling could trigger these pathways, but, if true, then it might be possible to duplicate cooling's protection pharmacologically. PMID:20621922

  20. Innate hypothermia after hypoxic ischaemic delivery.

    PubMed

    Jayasinghe, Dulip

    2015-01-01

    The focus of this review is to collate the literature on the phenomenon of impaired thermal adaptation after hypoxic ischaemic (HI) delivery often culminating in hypothermia. This phenomenon appears different in severity and duration to a spontaneous postnatal fall in temperature observed after normal delivery. The original observation and contemporary descriptions of the temperature response to HI are described and a mechanism of action is proposed that may be utilised as a novel biomarker for HI.

  1. Extended Use of Hypothermia in Elderly Patients with Malignant Cerebral Edema as an Alternative to Hemicraniectomy

    PubMed Central

    Jeong, Han-Yeong; Chang, Jun-Young; Yum, Kyu Sun; Hong, Jeong-Ho; Jeong, Jin-Heon; Yeo, Min-Ju; Bae, Hee-Joon; Han, Moon-Ku; Lee, Kiwon

    2016-01-01

    Background and Purpose The use of decompressive hemicraniectomy (DHC) for the treatment of malignant cerebral edema can decrease mortality rates. However, this benefit is not sufficient to justify its use in elderly patients. We investigated the effects of therapeutic hypothermia (TH) on safety, feasibility, and functional outcomes in elderly patients with malignant middle cerebral artery (MCA) infarcts. Methods Elderly patients 60 years of age and older with infarcts affecting more than two-thirds of the MCA territory were included. Patients who could not receive DHC were treated with TH. Hypothermia was started within 72 hours of symptom onset and was maintained for a minimum of 72 hours with a target temperature of 33°C. Modified Rankin Scale (mRS) scores at 3 months following treatment and complications of TH were used as functional outcomes. Results Eleven patients with a median age of 76 years and a median National Institutes of Health Stroke Scale score of 18 were treated with TH. The median time from symptom onset to initiation of TH was 30.3±23.0 hours and TH was maintained for a median of 76.7±57.1 hours. Shivering (100%) and electrolyte imbalance (82%) were frequent complications. Two patients died (18%). The mean mRS score 3 months following treatment was 4.9±0.8. Conclusions Our results suggest that extended use of hypothermia is safe and feasible for elderly patients with large hemispheric infarctions. Hypothermia may be considered as a therapeutic alternative to DHC in elderly individuals. Further studies are required to validate our findings. PMID:27488978

  2. [Death in a rainwater tank--unusual death by hypothermia].

    PubMed

    Doberentz, Elke; Madea, Burkhard

    2013-01-01

    Death due to hypothermia is often accidental and associated with alcohol intoxication, diseases or previous trauma. A very rare phenomenon is suicidal hypothermia. A 74-year-old depressive woman was found dead in a rain barrel with her head above the water level in February at an outdoor temperature of 0 degrees C. Forensic autopsy did not reveal any findings typical of drowning. Likewise, there was no morphological evidence of hypothermia, but this cannot be expected in immersion hypothermia with a very short agony. Unusual situations at scene always require comprehensive police investigations and medicolegal examinations.

  3. [Prolonged hypothermia in refractory intracranial hypertension. Report of one case].

    PubMed

    Rovegno, Maximiliano; Valenzuela, José Luis; Mellado, Patricio; Andresen, Max

    2012-02-01

    The use of hypothermia after cardiac arrest caused by ventricular fibrillation is a standard clinical practice, however its use for neuroprotection has been extended to other conditions. We report a 23-year-old male with intracranial hypertension secondary to a parenchymal hematoma associated to acute hydrocephalus. An arterial malformation was found and embolized. Due to persistent intracranial hypertension, moderate hypothermia with a target temperature of 33°C was started. After 12 hours of hypothermia, intracranial pressure was controlled. After 13 days of hypothermia a definitive control of intracranial pressure was achieved. The patient was discharged 40 days after admission, remains with a mild hemiparesia and is reassuming his university studies.

  4. The Osborn wave in accidental hypothermia.

    PubMed

    Aslan, Sahin; Erdem, Ali Fuat; Uzkeser, Mustafa; Cakir, Zeynep; Cakir, Murtaza; Akoz, Ayhan

    2007-04-01

    Hypothermia is generally defined as a core body temperature less than 35 degrees C (95 degrees F), and is one of the most common environmental emergencies encountered by emergency physicians. A 32-year-old male hunter was admitted to the hospital with altered mental status. He remained unconscious, Glasgow Coma Scale (GCS) score was recorded as 5/15, and pupils were dilated and unreactive. His vital signs showed a heart rate of 48 beats/min, respiratory rate of 10 breaths/min, blood pressure of 95/50 mm Hg, and rectal temperature of 31 degrees C. An electrocardiogram (ECG) was obtained and showed marked sinus bradycardia and J waves. His finger-stick glucose was 85. He was intubated. After 3 h of active rewarming, his temperature was 34 degrees C, and the repeat ECG showed near-complete resolution of the J waves and acceleration of the sinus rate to 68 beats/min. At the same time, emergency head computed tomography (CT) scan showed subarachnoid hemorrhage (SAH) and subdural hemorrhage. The patient died on the third day of admission. In this case we want to indicate that J waves and obtunded state could be due to either SAH or hypothermia, and SAH could have been missed if initial obvious hypothermia had been believed to cause all symptoms. PMID:17394990

  5. The effect of active warming in prehospital trauma care during road and air ambulance transportation - a clinical randomized trial

    PubMed Central

    2011-01-01

    Background Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientifical evidence of its effectiveness in a clinical setting is scarce. The objective of this study was to evaluate the effect of additional active warming during road or air ambulance transportation of trauma patients. Methods Patients were assigned to either passive warming with blankets or passive warming with blankets with the addition of an active warming intervention using a large chemical heat pad applied to the upper torso. Ear canal temperature, subjective sensation of cold discomfort and vital signs were monitored. Results Mean core temperatures increased from 35.1°C (95% CI; 34.7-35.5°C) to 36.0°C (95% CI; 35.7-36.3°C) (p < 0.05) in patients assigned to passive warming only (n = 22) and from 35.6°C (95% CI; 35.2-36.0°C) to 36.4°C (95% CI; 36.1-36.7°C) (p < 0.05) in patients assigned to additional active warming (n = 26) with no significant differences between the groups. Cold discomfort decreased in 2/3 of patients assigned to passive warming only and in all patients assigned to additional active warming, the difference in cold discomfort change being statistically significant (p < 0.05). Patients assigned to additional active warming also presented a statistically significant decrease in heart rate and respiratory frequency (p < 0.05). Conclusions In mildly hypothermic trauma patients, with preserved shivering capacity, adequate passive warming is an effective treatment to establish a slow rewarming rate and to reduce cold discomfort during prehospital transportation. However, the addition of active warming using a chemical heat pad applied to the torso will significantly improve thermal comfort even further and might also reduce the cold induced stress response. Trial Registration ClinicalTrials.gov: NCT01400152 PMID:22017799

  6. Architecture of a prehospital emergency patient care report system (PEPRS).

    PubMed

    Majeed, Raphael W; Stöhr, Mark R; Röhrig, Rainer

    2013-01-01

    In recent years, prehospital emergency care adapted to the technology shift towards tablet computers and mobile computing. In particular, electronic patient care report (e-PCR) systems gained considerable attention and adoption in prehospital emergency medicine [1]. On the other hand, hospital information systems are already widely adopted. Yet, there is no universal solution for integrating prehospital emergency reports into electronic medical records of hospital information systems. Previous projects either relied on proprietary viewing workstations or examined and transferred only data for specific diseases (e.g. stroke patients[2]). Using requirements engineering and a three step software engineering approach, this project presents a generic architecture for integrating prehospital emergency care reports into hospital information systems. Aim of this project is to describe a generic architecture which can be used to implement data transfer and integration of pre hospital emergency care reports to hospital information systems. In summary, the prototype was able to integrate data in a standardized manner. The devised methods can be used design generic software for prehospital to hospital data integration. PMID:23920925

  7. Prehospital use of plasma: the blood bankers' perspective.

    PubMed

    Hervig, Tor; Doughty, Heidi; Ness, Paul; Badloe, John F; Berseus, Olle; Glassberg, Elon; Heier, Hans E

    2014-05-01

    At the 2013 Traumatic Hemostasis and Oxygenation Research Network's Remote Damage Control Resuscitation symposium, a panel of senior blood bankers with both civilian and military background was invited to discuss their willingness and ability to supply prehospital plasma for resuscitation of massively bleeding casualties and to comment on the optimal preparations for such situations. Available evidence indicates that prehospital use of plasma may improve remote damage control resuscitation, although level I evidence is lacking. This practice is well established in several military services and is also being introduced in civilian settings. There are few, if any, clinical contraindications to the prehospital use of plasma, except for blood group incompatibility and the danger of transfusion-induced acute lung injury, which can be circumvented in various ways. However, the choice of plasma source, plasma preparation, and logistics including stock management require consideration. Staff training should include hemovigilance and traceability as well as recognition and management of eventual adverse effects. Prehospital use of plasma should occur within the framework of clinical algorithms and prospective clinical studies. Clinicians have an ethical responsibility to both patients and donors; therefore, the introduction of new clinical capabilities of transfusion must be safe, efficacious, and sustainable. The panel agreed that although these problems need further attention and scientific studies, now is the time for both military and civilian transfusion systems to prepare for prehospital use of plasma in massively bleeding casualties.

  8. [Severe accidental hypothermia in an elderly woman].

    PubMed

    Knobel, B; Mikhlin, A

    2001-11-01

    Profound hypothermia (core temperature of less than 28 degrees C) is a life threatening state and a medical emergency associated with a high mortality rate. The prognosis depends on underlying diseases, advanced or very early age, the duration prior to treatment, the degree of hemodynamic deterioration, and especially, the methods of treatment, including active external or internal rewarming. This is a case study of an 80-year-old female patient with severe accidental hypothermia (core temperature 27 degrees C). She was found in her home lying immobile on the cold floor after a fall. The patient was in a profound coma with cardiocirculatory collapse, and the medical staff treating her was inclined to pronounce her deceased. On her arrival at the hospital, she was resuscitated, put on a respirator and actively warmed. Very severe metabolic disorders were found, including a marked metabolic acidosis composed of diabetic ketoacidosis (she had suffered from insulin treated type 2 diabetes mellitus) and lactic acidosis with a very high anion gap (42) and a hyperosmotic state (blood glucose 1202 mg/dl). There were pathognomonic electrocardiographic abnormalities, J-wave of Osborn and prolonged repolarization. Slow atrial fibrillation with a ventricular response of 30 bpm followed by a nodal rhythm of 12 bpm and reversible cardiac arrest were recorded. The pulse and blood pressure were unobtainable. Despite the successful resuscitation and hemodynamic and cognitive improvement, rhabdomyolysis (CKP 6580 u/L), renal failure and hepatic damage developed. She was extubated and treated with intravenous fluids containing dopamine, bicarbonate, insulin and antibiotics. Her medical condition gradually improved, and she was discharged clear minded, functioning very well and independent. Renal and liver tests returned eventually to normal limits. Progressive bradycardia, hypotension and death due to ventricular fibrillation or asystole commonly occur during severe hypothermia

  9. Acute chest pain emergencies - spouses' prehospital experiences.

    PubMed

    Forslund, Kerstin; Quell, Robin; Sørlie, Venke

    2008-10-01

    The call to the Emergency Medical Dispatch Centre is often a person's first contact with the health-care system in cases of acute illness or injury and acute chest pain is a common reason for calling. The aim was to illuminate how spouses to persons with acute chest pain experienced the alarm situation, the emergency call and the prehospital emergency care. Interviews were conducted with nineteen spouses. A phenomenological-hermeneutic approach was used for the analyses. The themes responsibility and uneasiness emerged as well as an overall theme of aloneness. Being a spouse to a person in need of acute medical and nursing assistance was interpreted as "Being responsible and trying to preserve life" and "Being able to manage the uneasiness and having trust in an uncertain situation." When their partners' life was at risk the spouses were in an escalating spiral of worry, uncertainty, stress, fear of loss, feeling of loneliness and desperation. They had to manage emotional distress and felt compelled to act to preserve life, a challenging situation. PMID:18929341

  10. Theater Blood Support in the Prehospital Setting.

    PubMed

    Taylor, Audra L; Corley, Jason B

    2016-01-01

    The Army Blood Program (ABP) is charged with the responsibility of supporting the Warfighter on the battlefield, in addition to meeting garrison hospital blood requirements on a daily basis. Blood support concepts developed in response to Operation Iraqi Freedom/Operation Enduring Freedom combat operations are the cornerstone to maintaining current capabilities and shaping future endeavors.. The ABP is actively engaged with research, advanced development of blood products and medical technology to improve blood safety and efficacy for both our conventional and operational forces. The feasibility of frozen/deglycerolized red blood cell use in theater has been demonstrated. The use of Blood Group A plasma in the place of Blood Group AB plasma has been successful. Placement of cryoprecipitate at Role 2 medical facilities and the placement of blood products on MEDEVAC (Vampire Program missions) have proven invaluable in moving transfusion therapy closer to the point of Injury. The improved patient outcomes from earlier transfusion of blood products has driven the requirement for far-forward blood support. Now (more than ever), there are products and processes in place to meet the requirements for blood use in the prehospital setting. PMID:27215865

  11. Effect of extreme temperatures on drugs for prehospital ACLS.

    PubMed

    Johansen, R B; Schafer, N C; Brown, P I

    1993-09-01

    Advanced cardiac life support drugs undergo a wide range of temperature exposures in the prehospital setting. Although manufacturers place temperature restrictions for drug stability on their products, it has been shown that these limits are often exceeded in the prehospital environment. We exposed four different drugs to temperatures of -20 degrees C (-6 degrees F) and 70 degrees C (150 degrees F) and subsequently performed assays to determine their respective chemical stability compared with that of control samples. We determined that no significant difference in chemical structure occurred between the standard sample and the four drugs exposed to extreme temperatures (P > .05). This information has obvious implications in making further recommendations for drug storage. More work to determine bioactivity of temperature-exposed drugs may show results with implications for success in prehospital cardiac resuscitation.

  12. Management of pain in pre-hospital settings.

    PubMed

    Parker, Michael; Rodgers, Antony

    2015-06-01

    Assessment and management of pain in pre-hospital care settings are important aspects of paramedic and clinical team roles. As emergency department waiting times and delays in paramedic-to-nurse handover increase, it becomes more and more vital that patients receive adequate pre-hospital pain relief. However, administration of analgesia can be inadequate and can result in patients experiencing oligoanalgesia, or under-treated pain. This article examines these issues along with the aetiology of trauma and the related socioeconomic background of traumatic injury. It reviews validated pain-assessment tools, outlines physiological responses to traumatic pain and discusses some of the misconceptions about the provision of effective analgesia in pre-hospital settings. PMID:26050779

  13. Outcome following physician supervised prehospital resuscitation: a retrospective study

    PubMed Central

    Mikkelsen, Søren; Krüger, Andreas J; Zwisler, Stine T; Brøchner, Anne C

    2015-01-01

    Background Prehospital care provided by specially trained, physician-based emergency services (P-EMS) is an integrated part of the emergency medical systems in many developed countries. To what extent P-EMS increases survival and favourable outcomes is still unclear. The aim of the study was thus to investigate ambulance runs initially assigned ‘life-saving missions’ with emphasis on long-term outcome in patients treated by the Mobile Emergency Care Unit (MECU) in Odense, Denmark Methods All MECU runs are registered in a database by the attending physician, stating, among other parameters, the treatment given, outcome of the treatment and the patient's diagnosis. Over a period of 80 months from May 1 2006 to December 31 2012, all missions in which the outcome of the treatment was registered as ‘life saving’ were scrutinised. Initial outcome, level of competence of the caretaker and diagnosis of each patient were manually established in each case in a combined audit of the prehospital database, the discharge summary of the MECU and the medical records from the hospital. Outcome parameters were final outcome, the aetiology of the life-threatening condition and the level of competences necessary to treat the patient. Results Of 25 647 patients treated by the MECU, 701 (2.7%) received prehospital ‘life saving treatment’. In 596 (2.3%) patients this treatment exceeded the competences of the attending emergency medical technician or paramedic. Of these patients, 225 (0.9%) were ultimately discharged to their own home. Conclusions The present study demonstrates that anaesthesiologist administrated prehospital therapy increases the level of treatment modalities leading to an increased survival in relation to a prehospital system consisting of emergency medical technicians and paramedics alone and thus supports the concept of applying specialists in anaesthesiology in the prehospital setting especially when treating patients with cardiac arrest, patients in

  14. Hypothermia Increases Tissue Plasminogen Activator Expression and Decreases Post-Operative Intra-Abdominal Adhesion

    PubMed Central

    Lee, Chien-Chang; Wang, Hsuan-Mao; Chou, Tzung-Hsin; Wu, Meng-Che; Hsueh, Kuang-Lung; Chen, Shyr-Chyr

    2016-01-01

    Background Therapeutic hypothermia during operation decreases postoperative intra-abdominal adhesion formation. We sought to determine the most appropriate duration of hypothermia, and whether hypothermia affects the expression of tissue plasminogen activator (tPA). Methods 80 male BALB/c mice weighing 25–30 g are randomized into one of five groups: adhesion model with infusion of 15°C saline for 15 minutes (A); 30 minutes (B); 45 minute (C); adhesion model without infusion of cold saline (D); and sham operation without infusion of cold saline (E). Adhesion scores and tPA levels in the peritoneum fluid levels were analyzed on postoperative days 1, 7, and 14. Results On day 14, the cold saline infusion groups (A, B, and C) had lower adhesion scores than the without infusion of cold saline group (D). However, only group B (cold saline infusion for 30 minutes) had a significantly lower adhesion scores than group D. Also, group B was found to have 3.4 fold, 2.3 fold, and 2.2 fold higher levels of tPA than group D on days 1, 7, and 14 respectively. Conclusions Our results suggest that cold saline infusion for 30 minutes was the optimum duration to decrease postoperative intra-abdominal adhesion formation. The decrease in the adhesion formations could be partly due to an increase in the level of tPA. PMID:27583464

  15. Physiology of accidental hypothermia in the mountains: a forgotten story.

    PubMed

    Ainslie, P N; Reilly, T

    2003-12-01

    Hypothermia is a serious condition, often with fatal consequences. The physiology and mechanisms of hypothermia in mountainous areas are discussed. It is as important to facilitate heat loss, especially during periods of high exertion, as it is to maintain heat production and preserve insulation. This can be partly achieved by clothing adjustments. PMID:14665600

  16. Hypothermia-related mortality--Montana, 1999-2004.

    PubMed

    2007-04-20

    Hypothermia, defined as a core body temperature of <95 degrees F (35 degrees C), occurs in persons exposed to excessive cold. Although hypothermia can be fatal, it also is preventable. Risk factors for death from hypothermia include advanced age, substance abuse, altered mental status, and increased contact with substances that promote heat loss, such as water. Montana has an intensely cold and long winter. In December, the average daily minimum temperature is approximately 18.0 degrees F (-7.7 degrees C) and can remain at that level until March. For the entire year in Montana, the average daily minimum temperature is 35.9 degrees F (2.2 degrees C). During the period 1999-2004, Montana had the second highest (after Alaska) average annual hypothermia-related mortality rate (1.08 deaths per 100,000 population) in the United States, approximately five times greater than the U.S. rate overall. This report describes three examples of case reports of hypothermia-related deaths in Montana during 2005-2006, summarizes hypothermia-related mortality in the state during 1999-2004 (the most recent period for which annual data were available), and discusses hypothermia risk factors and prevention measures. Enhanced education and intervention strategies, particularly targeted to older adults, might reduce the number of deaths from hypothermia in Montana. PMID:17443122

  17. Mechanisms of Hypothermia, Delayed Hyperthermia and Fever Following CNS Injury

    EPA Science Inventory

    Central nervous system (CNS) damage is often associated with robust body temperature changes, such as hypothermia and delayed hyperthermia. Hypothermia is one of the most common body temperature changes to CNS insults in rodents and is often associated with improved outcome. Alth...

  18. Deep hypothermia for the treatment of refractory status epilepticus

    PubMed Central

    Niquet, Jerome; Baldwin, Roger; Gezalian, Michael; Wasterlain, Claude G.

    2015-01-01

    In a rat model of status epilepticus (SE) induced by lithium and pilocarpine and refractory to midazolam, deep hypothermia (20°C for 30 min.) reduced EEG power over 50-fold, stopped SE within 12 minutes, and reduced EEG spikes by 87%. Hypothermia deserves further investigation as a treatment of last resort for refractory SE. PMID:26198217

  19. Episodic spontaneous hypothermia with hyperhidrosis: implications for pathogenesis.

    PubMed

    Sheth, R D; Barron, T F; Hartlage, P L

    1994-02-01

    Unprovoked hypothermia is an unusual presenting sign. When occurring with diaphoresis it has been referred to as episodic spontaneous hypothermia with hyperhidrosis. Earlier reports described episodic, spontaneous hypothermia with hyperhidrosis in patients with agenesis of the corpus callosum and postulated a midline congenital malformation of the central nervous system. Since then, various endocrine, electrolyte, autonomic, and sleep disturbances have been described but the etiology remains undetermined. Three unrelated children are reported each of whom had an intact corpus callosum and normal endocrine function. Shivering was consistently absent despite marked symptomatic hypothermia. One child had spontaneous resolution of episodic spontaneous hypothermia with hyperhidrosis and two children responded to the antiserotonergic, cyproheptadine. It is hypothesized that specific serotonergic dysfunction in the anterior hypothalamic extrapyramidal shivering mechanism is central in the pathogenesis of this condition. PMID:8198674

  20. [Pathophysiology and management of perioperative hypothermia].

    PubMed

    Witkowski, Wojciech; Maj, Jakub

    2006-06-01

    The paper is a review of pathophysiology and management of perioperative hypothermia. The advanced methods of rewarming, such as passive and active: external and core used in clinic allow for efficient management ant prophylactics of hypothermia. Thermotherapy with use of infrared ceiling heaters CTS and mobile MTC as well as Infutherm system applying by authors are desirable and even indispensable in contemporary equipment of surgery clinics, cardiovascular surgery clinics and burn centers. The ideal rewarming method should be safe and enable fast, reliable and predictable warming or rewarming. The clinical parameter to determine the efficacy of rewarming is the change of core temperature. There is no doubt that active warming with forced-air warmers (Warm Touch 5700 and Bair Hugger 500) or radiative heaters (IR-A:Hydrosun 500, IR-C radiation: CTC X, MTC) is more effective than use of standard, passive insulation hospital blankets or convectional heaters. Actually the forced-air warmers are counted to be more useful in cardiovascular surgery hypothermia management, because of fast rate core temperature rise and faster rise in mean skin temperature compared to the control group. CTC X and MTC Aragona radiative heaters are useful in burn management being the most effective when the distance of heater from the patient body is less than 80 cm. The observation of 60 consecutive extensive burns leads to conclusion that long-lasting dressings in burn patients when the whole body is not covered and protected, can be performed safely only in conditions excluding heat losses and core temperature drop. While the cold intravenous fluids may significantly contribute to the temperature drop depending on the volume infused, the use of fluids warming systems as well as external heat application is absolutely indicated to improve the heat balance of the patient body. PMID:17007255

  1. Alpha-lipoic acid protects mitochondrial enzymes and attenuates lipopolysaccharide-induced hypothermia in mice

    EPA Science Inventory

    Abstract: Hypothermia is a key symptom of sepsis and the mechanism(s) leading to hypothermia during sepsis is largely unknown. To investigate a potential mechanism and find an effective treatment for hypothermia in sepsis, we induced hypothermia in mice by lipopolysaccharide (LP...

  2. Hypothermia during Carotid Endarterectomy: A Safety Study

    PubMed Central

    Candela, Serena; Dito, Raffaele; Casolla, Barbara; Silvestri, Emanuele; Sette, Giuliano; Filippi, Federico; Taurino, Maurizio; Brancadoro, Domitilla; Orzi, Francesco

    2016-01-01

    Background CEA is associated with peri-operative risk of brain ischemia, due both to emboli production caused by manipulation of the plaque and to potentially noxious reduction of cerebral blood flow by carotid clamping. Mild hypothermia (34–35°C) is probably the most effective approach to protect brain from ischemic insult. It is therefore a substantial hypothesis that hypothermia lowers the risk of ischemic brain damage potentially associated with CEA. Purpose of the study is to test whether systemic endovascular cooling to a target of 34.5–35°C, initiated before and maintained during CEA, is feasible and safe. Methods The study was carried out in 7 consecutive patients referred to the Vascular Surgery Unit and judged eligible for CEA. Cooling was initiated 60–90 min before CEA, by endovascular approach (Zoll system). The target temperature was maintained during CEA, followed by passive, controlled rewarming (0.4°C/h). The whole procedure was carried out under anesthesia. Results All the patients enrolled had no adverse events. Two patients exhibited a transient bradycardia (heart rate 30 beats/min). There were no significant differences in the clinical status, laboratory and physiological data measured before and after CEA. Conclusions Systemic cooling to 34.5–35.0°C, initiated before and maintained during carotid clamping, is feasible and safe. Trial Registration ClinicalTrials.gov NCT02629653 PMID:27058874

  3. The Parkmedic Program: prehospital care in the national parks.

    PubMed

    Kaufman, T I; Knopp, R; Webster, T

    1981-03-01

    The Parkmedic Program provides training and on-going supervision of national park rangers involved in advanced prehospital medical care in Yosemite, Kings Canyon, and Sequoia National Parks in California. This includes intravenous catheterization and drug administration in emergency situations. Course structure, experience to date, and recommendations for future programs are presented.

  4. Long-Term Effects of Induced Hypothermia on Local and Systemic Inflammation - Results from a Porcine Long-Term Trauma Model

    PubMed Central

    Horst, K.; Eschbach, D.; Pfeifer, R.; Relja, B.; Sassen, M.; Steinfeldt, T.; Wulf, H.; Vogt, N.; Frink, M.; Ruchholtz, S.; Pape, H. C.; Hildebrand, F.

    2016-01-01

    Background Hypothermia has been discussed as playing a role in improving the early phase of systemic inflammation. However, information on the impact of hypothermia on the local inflammatory response is sparse. We therefore investigated the kinetics of local and systemic inflammation in the late posttraumatic phase after induction of hypothermia in an established porcine long-term model of combined trauma. Materials & Methods Male pigs (35 ± 5kg) were mechanically ventilated and monitored over the study period of 48 h. Combined trauma included tibia fracture, lung contusion, liver laceration and pressure-controlled hemorrhagic shock (MAP < 30 ± 5 mmHg for 90 min). After resuscitation, hypothermia (33°C) was induced for a period of 12 h (HT-T group) with subsequent re-warming over a period of 10 h. The NT-T group was kept normothermic. Systemic and local (fracture hematoma) cytokine levels (IL-6, -8, -10) and alarmins (HMGB1, HSP70) were measured via ELISA. Results Severe signs of shock as well as systemic and local increases of pro-inflammatory mediators were observed in both trauma groups. In general the local increase of pro- and anti-inflammatory mediator levels was significantly higher and prolonged compared to systemic concentrations. Induction of hypothermia resulted in a significantly prolonged elevation of both systemic and local HMGB1 levels at 48 h compared to the NT-T group. Correspondingly, local IL-6 levels demonstrated a significantly prolonged increase in the HT-T group at 48 h. Conclusion A prolonged inflammatory response might reduce the well-described protective effects on organ and immune function observed in the early phase after hypothermia induction. Furthermore, local immune response also seems to be affected. Future studies should aim to investigate the use of therapeutic hypothermia at different degrees and duration of application. PMID:27144532

  5. Hypothermia secondary to glioblastoma multiforme? Autopsy findings in two cases.

    PubMed

    Morgan, Matthew; Schwartz, Liliana; Duflou, Johan

    2015-03-01

    Death due to accidental primary hypothermia in cold climates is relatively common, with previous case series reflecting this. In contrast, hypothermia-related death as a result of an underlying medical cause, such as a brain tumor, is rare. The literature clearly illustrates a theoretical causal relationship between brain neoplasms and hypothermia through the infiltration of the hypothalamus; however, the number of reported cases is minimal. Two cases are presented where autopsy confirmed hypothermia as the cause of death with both cases revealing widespread glioblastoma multiforme in the brain. Both decedents were elderly with a number of comorbidities identified during autopsy that could explain death; however, hypothermia was deemed the most likely cause. It is proposed that both decedents died of hypothermia as a result of the tumor's effect on thermoregulation. These cases underline the importance of forensic pathologists to be aware of the relationship between brain tumors and hypothermia and to not dismiss death as being due to other disease processes. PMID:25644717

  6. Early Prognostication Markers in Cardiac Arrest Patients Treated with Hypothermia

    PubMed Central

    Karapetkova, Maria; Koenig, Matthew A.; Jia, Xiaofeng

    2015-01-01

    Background and purpose Established prognostication markers, such as clinical findings, electroencephalography (EEG), and biochemical markers, used by clinicians to predict neurologic outcome after cardiac arrest (CA) are altered under therapeutic hypothermia (TH) conditions and their validity remains uncertain. Methods MEDLINE and EMBASE were searched for evidence on the current standards for neurologic outcome prediction for out-of-hospital CA patients treated with TH and the validity of a wide range of prognostication markers. Relevant studies that suggested one or several established biomarkers, and multimodal approaches for prognostication were included and reviewed. Results While the prognostic accuracy of various tests has been questioned after TH, pupillary light reflexes and somatosensory evoked potentials (SSEP) are still strongly associated with negative outcome for early prognostication. Increasingly, EEG background activity has also been identified as a valid predictor for outcome after 72 hours after CA and a preferred prognostic method in clinical settings. Neuroimaging techniques, such as MRI and CT, can identify functional and structural brain injury, but are not readily available at the patient’s bedside because of limited availability and high costs. Conclusions A multimodal algorithm composed of neurological examination, EEG-based quantitative testing, and SSEP, in conjunction with newer MRI sequences, if available, holds promise for accurate prognostication in CA patients treated with TH. In order to avoid premature withdrawal of care, prognostication should be performed later than 72 hours after CA. PMID:26228521

  7. Prehospital and in-hospital delays in acute stroke care.

    PubMed

    Evenson, K R; Rosamond, W D; Morris, D L

    2001-05-01

    Current guidelines emphasize the need for early stroke care. However, significant delays occur during both the prehospital and in-hospital phases of care, making many patients ineligible for stroke therapies. The purpose of this study was to systematically review and summarize the existing scientific literature reporting prehospital and in-hospital stroke delay times in order to assist future delivery of effective interventions to reduce delay time and to raise several key issues which future studies should consider. A comprehensive search was performed to find all published journal articles which reported on the prehospital or in-hospital delay time for stroke, including intervention studies. Since 1981, at least 48 unique reports of prehospital delay time for patients with stroke, transient ischemic attack, or stroke-like symptoms were published from 17 different countries. In the majority of studies which reported median delay times, the median time from symptom onset to arrival in the emergency department was between 3 and 6 h. The in-hospital times from emergency department arrival to being seen by an emergency department physician, initiation and interpretation of a computed tomography (CT) scan, and being seen by a neurologist were consistently longer than recommended. However, prehospital delay comprised the majority of time from symptom onset to potential treatment. Definitions and methodologies differed across studies, making direct comparisons difficult. This review suggests that the majority of stroke patients are unlikely to arrive at the emergency department and receive a diagnostic evaluation in under 3 h. Further studies of stroke delay and corresponding interventions are needed, with careful attention to definitions and methodologies. PMID:11359072

  8. Are pre-hospital deaths from accidental injury preventable?

    PubMed Central

    Hussain, L. M.; Redmond, A. D.

    1994-01-01

    OBJECTIVE--To determine what proportion of pre-hospital deaths from accidental injury--deaths at the scene of the accident and those that occur before the person has reached hospital--are preventable. DESIGN--Retrospective study of all deaths from accidental injury that occurred between 1 January 1987 and 31 December 1990 and were reported to the coroner. SETTING--North Staffordshire. MAIN OUTCOME MEASURES--Injury severity score, probability of survival (probit analysis), and airway obstruction. RESULTS--There were 152 pre-hospital deaths from accidental injury (110 males and 42 females). In the same period there were 257 deaths in hospital from accidental injury (136 males and 121 females). The average age at death was 41.9 years for those who died before reaching hospital, and their average injury severity score was 29.3. In contrast, those who died in hospital were older and equally likely to be males or females. Important neurological injury occurred in 113 pre-hospital deaths, and evidence of airway obstruction in 59. Eighty six pre-hospital deaths were due to road traffic accidents, and 37 of these were occupants in cars. On the basis of the injury severity score and age, death was found to have been inevitable or highly likely in 92 cases. In the remaining 60 cases death had not been inevitable and airway obstruction was present in up to 51 patients with injuries that they might have survived. CONCLUSION--Death was potentially preventable in at least 39% of those who died from accidental injury before they reached hospital. Training in first aid should be available more widely, and particularly to motorists as many pre-hospital deaths that could be prevented are due to road accidents. PMID:8173428

  9. Pediatric Anaphylaxis Management in the Prehospital Setting

    PubMed Central

    Arnold, Linda; Cone, David C.; Langhan, Melissa

    2013-01-01

    Purpose Anaphylaxis is a life-threatening systemic allergic reaction that occurs after contact with an allergy-causing substance. Timely administration of intramuscular epinephrine is the treatment of choice for controlling symptoms and decreasing fatalities. Our purpose was to investigate the prehospital management of anaphylaxis among patients receiving care in an urban tertiary care pediatric emergency department (PED). Methods We performed a retrospective chart review from May, 2008 to January, 2010 of patients 18 years or younger who received care in the PED for anaphylaxis. Data were extracted by one investigator and included demographic information, patient symptoms, past medical history, medications administered (including route and provider), and final disposition. Results We reviewed 218 cases of anaphylaxis in 202 children. Mean age of patients was 7.4 years; 56% of patients were male. Two hundred and fourteen (98%) manifested symptoms in the skin/mucosal system, 68% had respiratory symptoms, 44% had gastrointestinal symptoms, and 2% had hypotension. Sixty-seven percent had a previous history of allergic reaction and 38% had a history of asthma. Seventy-six percent of the patients presented with anaphylaxis to food products, 8% to medications, 1% to stings, and 16% to unknown allergens. Reactions occurred at home or with family members 87% of the time, and at school 12% of the time. Only 36% of the patients who met criteria for anaphylaxis had epinephrine administered by emergency medical services (EMS). Among 26 patients with anaphylactic reactions at school, 69% received epinephrine by the school nurse. Of the 117 patients with known allergies who were with their parents at the time of anaphylactic reaction, 41% received epinephrine. Thirteen patients were seen by a physician prior to coming to the PED; all received epinephrine at the physician’s office. In total, epinephrine was given to 41% (89) of the 218 cases prior to coming to the PED

  10. Mechanisms responsible for decreased glomerular filtration in hibernation and hypothermia

    NASA Technical Reports Server (NTRS)

    Tempel, G. E.; Musacchia, X. J.; Jones, S. B.

    1977-01-01

    Measurements of blood pressure, heart rate, red blood cell and plasma volumes, and relative distribution of cardiac output were made on hibernating and hypothermic adult male and female golden hamsters weighing 120-140 g to study the mechanisms underlying the elimination or marked depression of renal function in hibernation and hypothermia. The results suggest that the elimination or marked depression in renal function reported in hibernation and hypothermia may partly be explained by alterations in cardiovascular system function. Renal perfusion pressure which decreases nearly 60% in both hibernation and hypothermia and a decrease in plasma volume of roughly 35% in the hypothermic animal might both be expected to markedly alter glomerular function.

  11. Preventing admission hypothermia in very low birth weight neonates.

    PubMed

    Fawcett, Kristin

    2014-01-01

    Neonatal hypothermia, temperature < 36.5°C, is a major contributor to neonatal mortality and morbidity. hypothermia of preterm infants remains a challenge in the NiCU for many reasons. preterm very low birth weight (VlBW) infants, those infants born <1,500 g, are prone to very rapid heat losses through mechanisms of convection, evaporation, conduction, and radiation. this article reviews current research to reduce and prevent mortality and morbidity from hypothermia in preterm VlBW infants by implementing interventions in the delivery room to minimize heat loss and maintain core body temperatures. PMID:24816875

  12. Neurotensin analog NT77 induces regulated hypothermia in the rat.

    PubMed

    Gordon, Christopher J; McMahon, Beth; Richelson, Elliott; Padnos, Beth; Katz, Laurence

    2003-10-01

    The potential use of hypothermia as a therapeutic treatment for stroke and other pathological insults has prompted the search for drugs that can lower core temperature. Ideally, a drug is needed that reduces the set-point for control of core temperature (T(c)) and thereby induces a regulated reduction in T(c). To this end, a neurotensin analog (NT77) that crosses the blood brain barrier and induces hypothermia was assessed for its effects on the set-point for temperature regulation in the Sprague-Dawley rat by measuring behavioral and autonomic thermoregulatory responses. Following surgical implanation of radiotransmitters to monitor T(c), rats were placed in a temperature gradient and allowed to select from a range of ambient temperatures (T(a)) while T(c) was monitored by radiotelemetry. There was an abrupt decrease in selected T(a) from 29 to 16 degrees C and a concomitant reduction in T(c) from 37.4 to 34.0 degrees C 1 hr after IP injection of 5.0 mg/kg NT77. Selected T(a) and T(c) then recovered to control levels by 1.5 hr and 4 hr, respectively. Oxygen consumption (M) and heat loss (H) were measured in telemetered rats housed in a direct calorimeter maintained at a T(a) of 23.5 degrees C. Injection of NT77 initially led to a reduction in M, little change in H, and marked decrease in T(c). H initially rose but decreased around the time of the maximal decrease in T(c). Overall, NT77 appears to induce a regulated hypothermic response because the decrease in T(c) was preceded by a reduction in heat production, no change in heat loss, and preference for cold T(a)'s. Inducing a regulated hypothermic response with drugs such as NT77 may be an important therapy for ischemic disease and other insults. PMID:12967685

  13. Selecting cases for feedback to pre-hospital clinicians - a pilot study.

    PubMed

    Brichko, Lisa; Jennings, Paul; Bain, Christopher; Smith, Karen; Mitra, Biswadev

    2016-06-01

    Background There are currently limited avenues for routine feedback from hospitals to pre-hospital clinicians aimed at improvements in clinical practice. Objective The aim of this study was to pilot a method for selectively identifying cases where there was a clinically significant difference between the pre-hospital and in-hospital diagnoses that could have led to a difference in pre-hospital patient care. Methods This was a single-centre retrospective study involving cases randomly selected through informatics extraction of final diagnoses at hospital discharge. Additional data on demographics, triage and diagnoses were extracted by explicit chart review. Blinded groups of pre-hospital and in-hospital clinicians assessed data to detect clinically significant differences between pre-hospital and in-hospital diagnoses. Results Most (96.9%) patients were of Australasian Triage Scale category 1-3 and in-hospital mortality rate was 32.9%. Of 353 cases, 32 (9.1%; 95% CI: 6.1-12.1) were determined by both groups of clinical assessors to have a clinically significant difference between the pre-hospital and final in-hospital diagnoses, with moderate inter-rater reliability (kappa score 0.6, 95% CI: 0.5-0.7). Conclusion A modest proportion of cases demonstrated discordance between the pre-hospital and in-hospital diagnoses. Selective case identification and feedback to pre-hospital services using a combination of informatics extraction and clinician consensus approach can be used to promote ongoing improvements to pre-hospital patient care. What is known about the topic? Highly trained pre-hospital clinicians perform patient assessments and early interventions while transporting patients to healthcare facilities for ongoing management. Feedback is necessary to allow for continual improvements; however, the provision of formal selective feedback regarding diagnostic accuracy from hospitals to pre-hospital clinicians is currently not routine. What does this paper add? For a

  14. Accidental Hypothermia among the Elderly: An Educational Prevention Program.

    ERIC Educational Resources Information Center

    Goldstein, Marc B.

    1982-01-01

    Discusses the problem of hypothermia and specific factors that put older adults at risk. Describes the development, implementation, and evaluation of an educationally oriented prevention program. Data suggested the information presented through community education was effective. (Author/JAC)

  15. Some pharmacological correlations of hypothermia induced by anticholinesterasics.

    PubMed

    Voicu, V; Jiquidi, M; Sitcal, N; Bruja, N

    1976-01-01

    The investigations have been performed on Wistar rats intoxicated with paraoxon in toxic sublethal doses. There have been measured the variations of rectal temperature at various time periods following the anticholinesterase agent. The authors established the pharmacodynamic correlations of paraoxon-induced hypothermia with cholinesterase reactivators (toxogonin, isonitrosine), anticholinergic substances (atropine, butylscopolamine), carbamic anticholinesterase (eserine, neoeserine) and chlorpromazine. The efficiency of atropine and cholinesterase reactivators in antagonization of hypothermia induced by organophosphorics on the one hand, and only of atropine against hypothermia induced by carbamates on the other hand allow the hypothesis of a central cholinergic mechanism, predominantly muscarinic, involved in hypothermia induced by anticholinesterasics and of a direct correlation of this mechanism with phosphorylation or carbamylation processes of cerebral cholinesterases.

  16. [Prolonged hypothermia in refractory intracranial hypertension. Report of one case].

    PubMed

    Rovegno, Maximiliano; Valenzuela, José Luis; Mellado, Patricio; Andresen, Max

    2012-02-01

    The use of hypothermia after cardiac arrest caused by ventricular fibrillation is a standard clinical practice, however its use for neuroprotection has been extended to other conditions. We report a 23-year-old male with intracranial hypertension secondary to a parenchymal hematoma associated to acute hydrocephalus. An arterial malformation was found and embolized. Due to persistent intracranial hypertension, moderate hypothermia with a target temperature of 33°C was started. After 12 hours of hypothermia, intracranial pressure was controlled. After 13 days of hypothermia a definitive control of intracranial pressure was achieved. The patient was discharged 40 days after admission, remains with a mild hemiparesia and is reassuming his university studies. PMID:22739952

  17. The Ontario Prehospital Advanced Life Support (OPALS) Study: rationale and methodology for cardiac arrest patients.

    PubMed

    Stiell, I G; Wells, G A; Spaite, D W; Lyver, M B; Munkley, D P; Field, B J; Dagnone, E; Maloney, J P; Jones, G R; Luinstra, L G; Jermyn, B D; Ward, R; DeMaio, V J

    1998-08-01

    The Ontario Prehospital Advanced Life Support Study represents the largest prehospital study yet conducted, worldwide. This study will involve more than 25,000 cardiac arrest, trauma, and critically ill patients over an 8-year period. The study will evaluate the incremental benefit of rapid defibrillation and prehospital Advanced Cardiac Life Support measures for cardiac arrest survival and the benefit of Advanced Life Support for patients with traumatic injuries and other critically ill prehospital patients. This article describes the OPALS study with regard to the rationale and methodology for cardiac arrest patients.

  18. Effect of concurrent administration of apoptotic inhibitors and hypothermia on post hypoxic cerebral injury in the newborn.

    PubMed

    Delivoria-Papadopoulou, Maria; Malaeb, Shadi

    2014-01-01

    Neonatal hypoxic-ischemic encephalopathy is known to cause long-term neurodevelopmental impairment. Experimental studies and clinical trials demonstrated that treatment with hypothermia after hypoxic-ischemic insults reduced brain injury. As a result of these data, hypothermia has emerged as the standard of care for treatment of neonatal hypoxic-ischemic encephalopathy. However up to 40% of newborns with hypoxic-ischemic encephalopathy who are treated with hypothermia have significant neurocognitive deficits on follow-up. Obviously, there remains a need to further optimize cooling strategies and to identify adjuvant therapies that could potentially augment the neuroprotective effects and accentuate neuroprotection by hypothermia. As the occurrence of hypoxia in the newborn brain can not be predicted beforehand, the only opportunity we have to improve outcomes after hypoxic-ischemic encephalopathy is to pursue neuroprotective strategies that can be used as an adjunct to therapeutic hypothermia in the post-hypoxia-ischemia period, with special emphasis on mechanism mediating the early stages of hypoxic injury. Previously, we have demonstrated in the newborn piglet that within one hour of exposure to hypoxia, there is increased activation of the enzyme Ca++/calmodulin kinase (CaM Kinase) IV localized in the nucleus, a key regulator of transcription of apoptotic genes. We have also demonstrated that the hypoxia-induced enzyme CaM kinase IV activation is mediated by activation of two protein tyrosine kinases, Src kinase and EGFR kinase and by increased Ca++ influx into the nucleus. Inhibition of Src kinase by the selective inhibitor PP2 and of EGFR kinase by the selective inhibitor PD168393 at the onset of hypoxia prevented CaM kinase IV activation and decreased subsequent hypoxia-induced neuronal death. The aim of this study was to test the hypothesis that the combined treatment with hypothermia and PP2 (4-amino-5-(4-chlorophenyl)-7-(t-butyl)pyrazolo[3,4-d

  19. Hypothermia associated with clobazam use in adult epilepsy.

    PubMed

    Gauthier, Angela C; Quraishi, Imran H; Mattson, Richard H

    2016-01-01

    Clobazam, a 1,5-benzodiazepine FDA-approved in 2011, is commonly used to treat anxiety and epilepsy. It has not associated with hypothermia until very recently, in a case report involving two pediatric patients. Here, we report the first case of hypothermia development in an adult patient with epilepsy associated with clobazam use. A couple months after starting clobazam, the patient started developing episodes of hypothermia every several weeks, with temperatures ranging from 90 °F-95 °F. Normothermia was achieved with Bair Hugger therapy. Thyroid-stimulating hormone and cortisol levels were normal, and there was no evidence of infection in most instances. After 11 total episodes of hypothermia over a year of clobazam use, the drug was discontinued. It has now been 7 months after discontinuation, and the patient has not experienced any more episodes of hypothermia. Early recognition of the link between clobazam and hypothermia may prevent avoidable Emergency Department visits and hospitalizations. PMID:26870662

  20. [Pre-hospital medicine and medical control system in Japan].

    PubMed

    Tanabe, Seizan

    2016-02-01

    It is necessary to treat the patient from the site of the emergency to raise a lifesaving rate of the patient. As a prime example would be out-of-hospital cardiac arrest. Once you start the treatment after hospital arrival, cardiac arrest patient can't be life-saving. It is necessary to start the chest compression, etc. from the site of the emergency. Medical care to be carried out on the scene of emergency is the pre-hospital care. In recent years, improvement of the pre-hospital care is remarkable in Japan. It is because of that the quantity and quality of the emergency life-saving technician are being enhanced. And also doctor-helicopter system have been enhanced. Medical control is a critical component of the improvement. PMID:26915258

  1. A dramatic drop in blood pressure following prehospital GTN administration.

    PubMed

    Boyle, Malcolm J

    2007-03-01

    A male in his sixties with no history of cardiac chest pain awoke with chest pain following an afternoon sleep. The patient did not self medicate. The patient's observations were within normal limits, he was administered oxygen via a face mask and glyceryl trinitrate (GTN). Several minutes after the GTN the patient experienced a sudden drop in blood pressure and heart rate, this was rectified by atropine sulphate and a fluid challenge. There was no further deterioration in the patient's condition during transport to hospital. There are very few documented case like this in the prehospital scientific literature. The cause appears to be the Bezold-Jarish reflex, stimulation of the ventricular walls which in turn decreases sympathetic outflow from the vasomotor centre. Prehospital care providers who are managing any patient with a syncopal episode that fails to recover within a reasonable time frame should consider the Bezold-Jarisch reflex as the cause and manage the patient accordingly.

  2. Advanced communication infrastructure for pre-hospital EMS care.

    PubMed

    Orthner, Helmuth; Mazza, Giovanni; Mazza, Giovanni Giorgio; Shenvi, Rohit; Battles, Marcie

    2008-11-06

    The traditional communication infrastructure of the pre-hospital Emergency Medical System (EMS) is limited to voice communication using radio or cell phone technologies. With the emergence of 3rd Generation wireless networks (3G) and enhanced mobile devices capable of data communication (e.g., mobile tablets, PDAs with cell phones, or cell phones with PDA capabilities), the voice communication can be enhanced with interactive data messaging and perhaps even with interactive video communication. However, video requires substantially more bandwidth which 4th Generation (4G) systems are promising. However, their availability is limited. We present an infrastructure that allows dynamic selection of the best data transport mode in the pre-hospital EMS environment.

  3. Morphological study of the relation between accidental hypothermia and acute pancreatitis.

    PubMed Central

    Foulis, A K

    1982-01-01

    There is a recognised but poorly understood association between hypothermia and acute pancreatitis. A histological study of the pancreas was made in eight patients with accidental hypothermia who had evidence of pancreatitis at necropsy. From an analysis of the patterns of parenchymal necrosis in the pancreas it was thought that there were at least three possible mechanisms for the relation between hypothermia and pancreatitis. Firstly, that ischaemic pancreatitis may result from the "microcirculatory shock" of hypothermia. Secondly, that both hypothermia and pancreatitis may be secondary to alcohol abuse: and finally, that severe pancreatitis may be the primary disease and that hypothermia results from the patients' social circumstances. Images PMID:7142433

  4. Availability and quality of prehospital care on pakistani interurban roads.

    PubMed

    Bhatti, Junaid A; Waseem, Hunniya; Razzak, Junaid A; Shiekh, Naeem-Ul-Lah; Khoso, Ajmal Khan; Salmi, L-Rachid

    2013-01-01

    Interurban road crashes often result in severe Road Traffic Injuries (RTIs). Prehospital emergency care on interurban roads was rarely evaluated in the low- and middle-income countries. The study highlighted the availability and quality of prehospital care facilities on interurban roads in Pakistan, a low-income country. The study setting was a 592-km-long National highway in the province of Sindh, Pakistan. Using the questionnaires adapted from the World Health Organization prehospital care guidelines [Sasser et al., 2005], managers and ambulance staff at the stations along highways were interviewed regarding the process of care, supplies in ambulances, and their experience of trauma care. Ambulance stations were either managed by the police or the Edhi Foundation (EF), a philanthropic organization. All highway stations were managed by the EF; the median distance between highway stations was 38 km (Interquartile Range [IQR]=27-46). We visited 14 stations, ten on the highway section, and four in cities, including two managed by the police. Most highway stations (n=13) received one RTI call per day. Half of stations (n=5) were inside highway towns, usually near primary or secondary-level healthcare facilities. Travel time to the nearest tertiary healthcare facility ranged from 31 to 70 minutes (median=48 minutes; IQR=30-60). Other shortcomings noted for stations were not triaging RTI cases (86%), informing hospitals (64%), or recording response times (57%). All ambulances (n=12) had stretchers, but only 58% had oxygen cylinders. The median schooling of ambulance staff (n=13) was 8 years (IQR=3-10), and the median paramedic training was 3 days (IQR=2-3). Observed shortcomings in prehospital care could be improved by public-private partnerships focusing on paramedic training, making available essential medical supplies, and linking ambulance stations with designated healthcare facilities for appropriate RTI triage.

  5. Prehospital care for multiple trauma patients in Germany.

    PubMed

    Maegele, Marc

    2015-01-01

    For the German speaking countries, Tscherne's definition of "polytrauma" which represents an injury of at least two body regions with one or a combination being life-threatening is still valid. The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care. The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system. The "Primary Survey" is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support (PHTLS)-concept. The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis ("treat-first-what-kills-first"). If no immediate treatment is necessary, a "Secondary Sur- vey" follows with careful and structured body examination and detailed assessment of the trauma mechanism. Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme. Critical trauma patients should be referred without any delay ("work and go")toTR-DGU® certified trauma centers of the local trauma networks. Due to the difficult pre- hospital environment the number of quality studies in the field is low and, as consequence, the level of evidence for most recommendations is also low. Much information has been obtained from different care systems and the interchangeability of results is limited. The present article provides a synopsis of rec- ommendations for early prehospital care for the severely injured based upon the 2011 updated multi- disciplinary S3-Guideline "Polytrauma/Schwerstverletzten Behandlung", the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible. PMID:26643236

  6. Endotracheal Intubation in Patients Treated for Prehospital Status Epilepticus

    PubMed Central

    Miller, Joseph B.; Nicholas, Katherine S.; Varelas, Panayiotis N.; Harsh, Donna M.; Durkalski, Valerie; Silbergleit, Robert; Wang, Henry E.

    2015-01-01

    Introduction Limited data describe the frequency, timing, or indications for endotracheal intubation (ETI) in patients with status epilepticus. A better understanding of the characteristics of patients with status epilepticus requiring airway interventions could inform clinical care. We sought to characterize ETI use in patients with prehospital status epilepticus. Methods This study was a secondary analysis of the Rapid Anticonvulsant Medication Prior to Arrival Trial, a multi-center, randomized trial comparing intravenous lorazepam to intramuscular midazolam for prehospital status epilepticus treatment. Subjects received ETI in the prehospital, Emergency Department (ED), or inpatient setting at the discretion of caregivers. Results Of 1023 enrollments, 218 (21 %) received ETI. 204 (93.6 %) of the ETIs were performed in the hospital and 14 (6.4 %) in the prehospital setting. Intubated patients were older (52 vs 41 years, p < 0.001), and men underwent ETI more than women (26 vs 21 %, p = 0.047). Patients with ongoing seizures on ED arrival had a higher rate of ETI (32 vs 16 %, p < 0.001), as did those who received rescue anti-seizure medication (29 vs 20 %, p = 0.004). Mortality was higher for intubated patients (7 vs 0.4 %, p < 0.001). Most ETI (n = 133, 62 %) occurred early (prior to or within 30 min after ED arrival), and late ETI was associated with higher mortality (14 vs 3 %, p = 0.002) than early ETI. Conclusions ETI is common in patients with status epilepticus, particularly among the elderly or those with refractory seizures. Any ETI and late ETI are both associated with higher mortality. PMID:25623785

  7. Acute Stroke: Current Evidence-based Recommendations for Prehospital Care

    PubMed Central

    Glober, Nancy K.; Sporer, Karl A.; Guluma, Kama Z.; Serra, John P.; Barger, Joe A.; Brown, John F.; Gilbert, Gregory H.; Koenig, Kristi L.; Rudnick, Eric M.; Salvucci, Angelo A.

    2016-01-01

    Introduction In the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods We performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the stroke protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were the use of a stroke scale, blood glucose evaluation, use of supplemental oxygen, patient positioning, 12-lead electrocardiogram (ECG) and cardiac monitoring, fluid assessment and intravenous access, and stroke regionalization. Results Protocols across EMS agencies in California varied widely. Most used some sort of stroke scale with the majority using the Cincinnati Prehospital Stroke Scale (CPSS). All recommended the evaluation of blood glucose with the level for action ranging from 60 to 80mg/dL. Cardiac monitoring was recommended in 58% and 33% recommended an ECG. More than half required the direct transport to a primary stroke center and 88% recommended hospital notification. Conclusion Protocols for a patient with a suspected stroke vary widely across the state of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols. PMID:26973735

  8. Man or machine? An experimental study of prehospital emergency amputation

    PubMed Central

    Leech, Caroline; Porter, Keith

    2016-01-01

    Objective Prehospital emergency amputation is a rare procedure, which may be necessary to free a time-critical patient from entrapment. This study aimed to evaluate four techniques of cadaveric lower limb prehospital emergency amputation. Method A guillotine amputation of the distal femur was undertaken in fresh frozen self-donated cadavers. A prehospital doctor conducted a surgical amputation with Gigli saw or hacksaw for bone cuts and firefighters carried out the procedure using the reciprocating saw and Holmatro device. The primary outcome measures were time to full amputation and the number of attempts required. The secondary outcomes were observed quality of skin cut, soft tissue cut and CT assessment of the proximal bone. Observers also noted the potential risks to the rescuer or patient during the procedure. Results All techniques completed amputation within 91 s. The reciprocating saw was the quickest technique (22 s) but there was significant blood spattering and continuation of the cut to the surface under the leg. The Holmatro device took less than a minute. The quality of the proximal femur was acceptable with all methods, but 5 cm more proximal soft tissue damage was made by the Holmatro device. Conclusions Emergency prehospital guillotine amputation of the distal femur can effectively be performed using scalpel and paramedic shears with bone cuts by the Gigli saw or fire service hacksaw. The reciprocating saw could be used to cut bone if no other equipment was available but carried some risks. The Holmatro cutting device is a viable option for a life-threatening entrapment where only firefighters can safely access the patient, but would not be a recommended primary technique for medical staff. PMID:27280425

  9. Neurologic Injury Associated with Rewarming from Hypothermia: Is Mild Hypothermia on Bypass Better than Deep Hypothermic Circulatory Arrest?

    PubMed Central

    Bhalala, Utpal S.; Appachi, Elumalai; Mumtaz, Muhammad Ali

    2016-01-01

    Many known risk factors for adverse cardiovascular and neurological outcomes in children with congenital heart defects (CHD) are not modifiable; however, the temperature and blood flow during cardiopulmonary bypass (CPB), are two risk factors, which may be altered in an attempt to improve long-term neurological outcomes. Deep hypothermic circulatory arrest, traditionally used for aortic arch repair, has been associated with short-term and long-term neurologic sequelae. Therefore, there is a rising interest in using moderate hypothermia with selective antegrade cerebral blood flow on CPB during aortic arch repair. Rewarming from moderate-to-deep hypothermia has been shown to be associated with neuronal injury, neuroinflammation, and loss of cerebrovascular autoregulation. A significantly lesser degree of rewarming is required following mild (33–35°C) hypothermia as compared with moderate (28–32°C), deep (21–27°C), and profound (less than 20°C) hypothermia. Therefore, we believe that mild hypothermia is associated with a lower risk of rewarming-induced neurologic injury. We hypothesize that mild hypothermia with selective antegrade cerebral perfusion during CPB for neonatal aortic arch repair would be associated with improved neurologic outcome. PMID:27734011

  10. [A historical retrospect of Pre-hospital emergency treatment].

    PubMed

    Li, Yan; Li, Peng; Cui, Yong-Ying; Wang, Zhen-E

    2013-07-01

    In 1240, the first organization of first aid medical service for rescuing and transferring the wounded in the world was established at Florence, Italy. The stations of Air Ambulances were set up in most of the developed countries at the end of the 1960s. In the middle of the 1970s, the International Red Cross put forward the principles of internationalization, international cooperation and its standardization, thus, promoting the development of pre-hospital emergency treatment. In 1972, the first Emergency Medical Service Center was established and in 1973, Congress of the United States passed the Emergency Medical Services Act (EMSS). In 1976, the legislative procedure was finished and the National Emergency Network was formed, afterwards, pre-hospital emergency treatment, on-site rescue and transfer care, patient monitoring system of ICU-CCU were set up successively. Since the first rescue group of "three failure" (heart failure, lung failure and renal failure) was first formed at Tianjin First Center Hospital in August 1974, the pre-hospital emergency of China had been developing gradually. PMID:24345547

  11. Understanding prehospital delay behavior in acute myocardial infarction in women.

    PubMed

    Waller, Cynthia G

    2006-12-01

    Studies demonstrate that acute myocardial infarction (AMI) mortality can be reduced if reperfusion therapy is initiated within 1 hour of AMI symptom onset. However, a considerable number of men and women arrive at the emergency department outside of the time frame for thrombolytic and angioplasty effectiveness. This is especially true for women who have been shown to delay longer than men due to their prehospital decision-making process utilized. With a mean total delay time greater than 4 hours, the time interval from symptom onset to transport activation to the hospital consumes the majority of the prehospital phase of emergency cardiac care. The health belief model, self-regulation model, theory of reasoned action, and theory of planned behavior have all been used to describe the prehospital decision-making process of both men and women with an AMI and the variables that impact that process. These models have identified the importance of symptom attribution to cardiac-related causes as a target variable for research and interventions related to care-seeking behavior.

  12. Understanding prehospital delay behavior in acute myocardial infarction in women.

    PubMed

    Waller, Cynthia G

    2006-12-01

    Studies demonstrate that acute myocardial infarction (AMI) mortality can be reduced if reperfusion therapy is initiated within 1 hour of AMI symptom onset. However, a considerable number of men and women arrive at the emergency department outside of the time frame for thrombolytic and angioplasty effectiveness. This is especially true for women who have been shown to delay longer than men due to their prehospital decision-making process utilized. With a mean total delay time greater than 4 hours, the time interval from symptom onset to transport activation to the hospital consumes the majority of the prehospital phase of emergency cardiac care. The health belief model, self-regulation model, theory of reasoned action, and theory of planned behavior have all been used to describe the prehospital decision-making process of both men and women with an AMI and the variables that impact that process. These models have identified the importance of symptom attribution to cardiac-related causes as a target variable for research and interventions related to care-seeking behavior. PMID:18340239

  13. Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment.

    PubMed

    Amadi-Obi, Ahjoku; Gilligan, Peadar; Owens, Niall; O'Donnell, Cathal

    2014-01-01

    The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality research, should be developed. Telemedicine is well suited to extending the reach of specialist services particularly in the pre-hospital care of acute emergencies where treatment delays may affect clinical outcome. The exponential growth in research and development in telemedicine has led to improvements in clinical outcomes in emergency medical care. This review is part of the LiveCity project to examine the history and existing applications of telemedicine in the pre-hospital environment. A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,279 articles reviewed, 39 met the inclusion criteria and were critically analysed. A majority of the studies were on stroke management. The studies suggested that overall, telemedicine had a positive impact on emergency medical care. It improved the pre-hospital diagnosis of stroke and myocardial infarction and enhanced the supervision of delivery of tissue thromboplasminogen activator in acute ischaemic stroke. Telemedicine presents an opportunity to enhance patient management. There are as yet few definitive studies that have demonstrated whether it had an effect on clinical outcome. PMID:25635190

  14. HYPOTHERMIA AND VALPROIC ACID ACTIVATE PRO-SURVIVAL PATHWAYS AFTER HEMORRHAGE

    PubMed Central

    Bambakidis, Ted; Dekker, Simone E.; Liu, Baoling; Maxwell, Jake; Chatraklin, Kiril; Linzel, Durk; Li, Yongqing; Alam, Hasan B.

    2015-01-01

    Background Therapeutic hypothermia (Hypo) and valproic acid (VPA, a histone deacetylase inhibitor) have independently been shown to be protective in models of trauma and hemorrhagic shock (HS), but require logistically challenging doses to be effective. Theoretically, combined treatment may further enhance effectiveness, allowing us to use lower doses of each modality. The aim of this study was to determine whether a combination of mild hypothermia and VPA treatments would offer better cytoprotection compared to individual treatments in a hemorrhage model. Materials and methods Male Sprague-Dawley rats were subjected to 40% volume-controlled hemorrhage, kept in shock for 30 minutes, and assigned to one of the following treatment groups: normothermia (36–37°C), Hypo (30±2°C), normothermia+VPA (300mg/kg), and Hypo+VPA (n=5/group). After three hours of observation, the animals were sacrificed, liver tissue was harvested and subjected to whole cell lysis, and levels of key proteins in the pro-survival Akt pathway were measured using Western Blot. Results Activation of the pro-apoptotic protein cleaved-caspase-3 was significantly lower in the combined treatment group relative to normothermia (P<0.05). Levels of the pro-survival Bcl-2 was significantly higher in the combined treatment group relative to sham, normothermia, and normothermia+VPA groups (P<0.005). The downstream pro-survival protein phospho-GSK-3β was significantly higher in the sham, Hypo, and combined treatment groups compared to normothermia groups with or without VPA (P<0.05). Levels of the pro-survival β-catenin were significantly higher in the combined treatment group relative to normothermia (P<0.01). Conclusions This is the first in-vivo study to demonstrate that combined treatment with VPA and hypothermia offers better cytoprotection than these treatments given independently. PMID:25777823

  15. Treatment of acute carbon monoxide poisoning with induced hypothermia

    PubMed Central

    Oh, Byoung-Joon; Im, Yong-Gyun; Park, Eunjung; Min, Young-Gi; Choi, Sang-Cheon

    2016-01-01

    Objective The effect of induced hypothermia on severe acute carbon monoxide (CO) poisoning remains to be addressed further. We investigated the effect of induced hypothermia on severe acute CO poisoning. Methods Retrospective chart review was conducted for patients who diagnosed as severe acute CO poisoning in emergency department and underwent induced hypothermia from May 2013 to May 2014. Hospital courses with critical medication and major laboratory results were investigated through the chart review. Results Among total 227 patients with acute CO poisoning during the period of study, patients with severe acute CO poisoning were 15. All patients underwent induced hypothermia with a temperature goal 33°C. Initial and follow-up levels of S100B protein after induced hypothermia were 0.47 μg/L (interquartile range, 0.11 to 0.71) and 0.10 μg/L (interquartile range, 0.06 to 0.37), respectively (P = 0.01). The mean Glasgow Coma Scales at emergency department admission was 6.87 ± 3.36. Except 1 patient who expired after cardiopulmonary resuscitation, Glasgow Coma Scales at 30-day of hospital discharge were 15 in 10 patients (71.4%), 14 in 1 patient (7.1%), 13 in 1 patient (7.1%), and 6 in 2 patients (14.2%). Seven patients (46.7%) developed delayed neurologic sequelae. Four patients showed mild types of delayed neurologic sequelae and 3 showed moderate to severe types of delayed neurologic sequelae. Conclusion Most of patients underwent induced hypothermia had a good recovery from severe acute CO poisoning. Therefore, induced hypothermia may be considered as a possible treatment in severe acute CO poisoning. PMID:27752625

  16. Understanding Safety in Prehospital Emergency Medical Services for Children

    PubMed Central

    Cottrell, Erika K.; O’Brien, Kerth; Curry, Merlin; Meckler, Garth D.; Engle, Philip P.; Jui, Jonathan; Summers, Caitlin; Lambert, William; Guise, Jeanne-Marie

    2014-01-01

    Objective For over a decade, the field of medicine has recognized the importance of studying and designing strategies to prevent safety issues in hospitals and clinics. However, there has been less focus on understanding safety in prehospital emergency medical services, particularly in regard to children. Roughly 27.7 million (or 27%) of the annual ED visits are by children under the age of 19, and about 2 million of these children reach the hospital via EMS. This paper adds to our qualitative understanding of the nature and contributors to safety events in the prehospital emergency care of children. Methods We conducted four 8–12 person focus groups among paid and volunteer Emergency Medical Services providers to understand: 1) patient safety issues that occur in the prehospital care of children, and 2) factors that contribute to these safety issues (e.g. patient, family, systems, environmental, or individual provider factors). Focus groups were conducted in rural and urban settings. Interview transcripts were coded for overarching themes. Results Key factors and themes identified in the analysis were grouped into categories using an ecological approach that distinguishes between systems, team, child and family, and individual provider level contributors. At the systems level, focus group participants cited challenges such as lack of appropriately sized equipment or standardized pediatric medication dosages, insufficient human resources, limited pediatric training and experience, and aspects of emergency medical services culture. EMS team level factors centered on communication with other EMS providers (both prehospital and hospital). Family and child factors included communication barriers and challenging clinical situations or scene characteristics. Finally, focus group participants highlighted a range of provider level factors including heightened levels of anxiety, insufficient experience and training with children and errors in assessment and decision

  17. Prehospital diagnosis of massive ethylene glycol poisoning and use of an early antidote.

    PubMed

    Amathieu, Roland; Merouani, Medhi; Borron, Stephen W; Lapostolle, Frédéric; Smail, Nadia; Adnet, Frédéric

    2006-08-01

    We report the case of a patient suspected of voluntary massive poisoning by ethylene glycol. Prehospital diagnosis was established by portable blood analyser and an early antidote with 4 MP treatment initiated in out-of-hospital setting. Use of portable blood analyser in prehospital care should be considered in case of suspected massive poisoning by ethylene glycol. PMID:16808995

  18. [Successful resuscitation in accidental hypothermia following drowning].

    PubMed

    Fritz, K W; Kasperczyk, W; Galaske, R

    1988-05-01

    After breaking through thin ice, a 4-year-old boy drowned in a lake. A quickly alerted rescue helicopter found and recovered the child, drifting underneath the clear, thin ice. Primary resuscitation by the helicopter crew was unsuccessful. Upon arrival in the hospital the child had fixed, dilated pupils and asystole. Core temperature was 19.8 degrees C. Rewarming was conducted slowly while cardiopulmonary resuscitation was continued. Twenty minutes after arrival at the hospital, ventricular complexes appeared in the ECG (temperature 22.1 degrees C); after another 10 min this converted to sinus rhythm. At short intervals, blood gas analyses and electrolyte determinations were carried out and corrected adequately. For cerebral protection methohexital was given and the child was hyperventilated. Seventy minutes after arrival at the hospital the child was brought to the pediatric ICU with stable circulation. There, further rewarming (centrally/peripherally combined) was carried out, aiming at 1 degree C rewarming per hour until a normal temperature was reached. The patient had to be kept on the ventilator for 10 days and after another 2 weeks was discharged home. He had recovered completely without any cerebral damage. One of the reasons why 88 min of cardiac arrest were tolerated by this patient without sequelae may have been rapid and deep hypothermia.

  19. Safety and efficacy of topiramate in neonates with hypoxic ischemic encephalopathy treated with hypothermia (NeoNATI)

    PubMed Central

    2012-01-01

    neurologic and neuroradiologic examinations. Visual function will be evaluated by means of behavioural standardized tests. Discussion This pilot study will explore the possible therapeutic role of topiramate in combination with moderate hypothermia. Any favourable results of this research might open new perspectives about the reduction of cerebral damage in asphyxiated newborns. Trial registration Current Controlled Trials ISRCTN62175998; ClinicalTrials.gov Identifier NCT01241019; EudraCT Number 2010-018627-25 PMID:22950861

  20. [Acetaminophen-induced hypothermia, an AIDS related side-effect? About 4 cases].

    PubMed

    Denes, Eric; Amaniou, Monique; Rogez, Jean-Philippe; Weinbreck, Pierre; Merle, Louis

    2002-10-01

    Hypothermia is an uncommon side effect of acetaminophen. We report 4 cases of HIV-infected patients who developed hypothermia after intravenous injection of propacetamol (the parenteral formulation of acetaminophen). The mechanism of this hypothermia is unknown. AIDS-induced changes in the metabolism of acetaminophen, could be an explanation. AIDS-associated opportunistic diseases may account for part of the mechanism. These hypothermias occur within 6 hours after the injection, are well tolerated and regress spontaneously. PMID:12486392

  1. Environmental hypothermia in porcine polytrauma and hemorrhagic shock is safe.

    PubMed

    Iyegha, Uroghupatei P; Greenberg, Joseph J; Mulier, Kristine E; Chipman, Jeffrey; George, Mark; Beilman, Greg J

    2012-10-01

    We have previously demonstrated survival benefit to induced hypothermia in a porcine model of controlled hemorrhagic shock simulating an associated delay to definitive care. In the current study, we wished to evaluate the effects of environmental hypothermia in a porcine model of hemorrhagic shock with the addition of polytrauma. Sixteen pigs were randomized to normothermic (39°C, n = 7) or hypothermic (34°C, n = 9) groups. The model included instrumentation, chest injury (captive bolt device), hemorrhage to systolic blood pressure (SBP) of ∼50 mmHg, and crush liver injury. Animals received limited fluid resuscitation for a 1-h period with goal SBP of greater than 80 mmHg and ice packs or warming blankets to achieve goal temperatures, followed by full resuscitation with goal SBP of greater than 90 mmHg, adequate urine output, and hemoglobin by protocol for 20 h. Survivors were observed for an additional 24 h with end points including mortality, markers of organ injury, and neurologic function. There were no differences in survival between the groups (mortality = 1/9, hypothermia group vs. 2/7, normothermia group, P = 0.39). Markers of organ injury were elevated in the hypothermia group at 24 h after injury but were identical between groups at the end of the experimental protocol (48 h after injury). There were no noted differences in neurologic function between the two groups. Environmental hypothermia in a model of polytrauma and hemorrhagic shock was not associated with worse outcomes. PMID:22777118

  2. Automatic Incubator-type Temperature Control System for Brain Hypothermia Treatment

    NASA Astrophysics Data System (ADS)

    Gaohua, Lu; Wakamatsu, Hidetoshi

    An automatic air-cooling incubator is proposed to replace the manual water-cooling blanket to control the brain tissue temperature for brain hypothermia treatment. Its feasibility is theoretically discussed as follows: First, an adult patient with the cooling incubator is modeled as a linear dynamical patient-incubator biothermal system. The patient is represented by an 18-compartment structure and described by its state equations. The air-cooling incubator provides almost same cooling effect as the water-cooling blanket, if a light breeze of speed around 3 m/s is circulated in the incubator. Then, in order to control the brain temperature automatically, an adaptive-optimal control algorithm is adopted, while the patient-blanket therapeutic system is considered as a reference model. Finally, the brain temperature of the patient-incubator biothermal system is controlled to follow up the given reference temperature course, in which an adaptive algorithm is confirmed useful for unknown environmental change and/or metabolic rate change of the patient in the incubating system. Thus, the present work ensures the development of the automatic air-cooling incubator for a better temperature regulation of the brain hypothermia treatment in ICU.

  3. Early predictors of outcome in infants treated with hypothermia for hypoxic-ischaemic encephalopathy.

    PubMed

    Merchant, Nazakat; Azzopardi, Denis

    2015-04-01

    Hypoxic-ischaemic encephalopathy (HIE) is a leading cause of acquired neonatal brain injury. Assessment of the severity of cerebral injury and likely neurological outcome in infants with HIE is important for determining management and prognosis, for counselling parents, and for selection for neuroprotective trials. The condition of the infant at birth, the severity of HIE, neurophysiological tests, including amplitude-integrated electroencephalography (aEEG), biochemical markers, and neuroimaging have been used to assess prognosis and predict long-term outcome. The predictive accuracy of these indicators in the early postnatal period is modest. Neurophysiological assessment seems to be most helpful during the first 24 to 48 hours after birth whilst magnetic resonance imaging (MRI) seems most informative later. Several biochemical markers, including serum S100β and neuron-specific enolase (NSE), are also associated with HIE but their levels depend on the timing of sampling and their prognostic value is uncertain. Comprehensive neurophysiological assessment and neuroimaging may be limited to specialist centres. Therapeutic hypothermia is now standard care in infants with moderate to severe HIE so it is important to examine the influence of hypothermia on the assessment of prognosis in these infants.

  4. Early predictors of outcome in infants treated with hypothermia for hypoxic-ischaemic encephalopathy.

    PubMed

    Merchant, Nazakat; Azzopardi, Denis

    2015-04-01

    Hypoxic-ischaemic encephalopathy (HIE) is a leading cause of acquired neonatal brain injury. Assessment of the severity of cerebral injury and likely neurological outcome in infants with HIE is important for determining management and prognosis, for counselling parents, and for selection for neuroprotective trials. The condition of the infant at birth, the severity of HIE, neurophysiological tests, including amplitude-integrated electroencephalography (aEEG), biochemical markers, and neuroimaging have been used to assess prognosis and predict long-term outcome. The predictive accuracy of these indicators in the early postnatal period is modest. Neurophysiological assessment seems to be most helpful during the first 24 to 48 hours after birth whilst magnetic resonance imaging (MRI) seems most informative later. Several biochemical markers, including serum S100β and neuron-specific enolase (NSE), are also associated with HIE but their levels depend on the timing of sampling and their prognostic value is uncertain. Comprehensive neurophysiological assessment and neuroimaging may be limited to specialist centres. Therapeutic hypothermia is now standard care in infants with moderate to severe HIE so it is important to examine the influence of hypothermia on the assessment of prognosis in these infants. PMID:25800487

  5. [HYPOTHERMIA INFLUENCES ON OXYGEN TENSION IN THE BRAIN PARENCHYMA IN PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE].

    PubMed

    Abudeev, S A; Popugaev, K A; Kruglyakov, N M; Belousova, K A; Terekhov, D A; Leushin, K Yu; Aronov, M S; Karpova, O V; Zelenkov, A V; Kiselev, K V; Fedin, A B; Zabelin, M V; Samoylov, A S

    2016-01-01

    Aneurysmal subarachnoid hemorrhage is a serious medical and social problem. The main physiological mechanisms that determine secondary brain damage in this patients are intracranial hypertension, cerebral vasospasm, dysfunction of autoregulation mechanisms, violation of liquorodynamics and delayed cerebral ischemia. The multimodal neuromonitoring for prevention and timely correction ofsecondary brain injury factors has become routine practice in neuroICU. Measurement of oxygen tension in the brain parenchyma is one of neuromonitoring options. During the years of intensive use of this method in clinical practice the reasons for reducing the oxygen tension in the brain parenchyma were revealed, as well as developed and clinically validated algorithms for correction of such conditions. However, there are clinical situations that are difficult to interpret and even more difficult to make the right tactical and therapeutic solutions. We present the clinical observation of the patient with aneurysmal subarachnoid hemorrhage, who had dramatically reduced brain intraparenchymal oxygen pressure although prolonged hypothermia were used. Despite this, the outcome was favorable. The analysis allowed to assume that the reason for this decrease in oxygen tension in the brain parenchyma could be hypothermia itself PMID:27468510

  6. Nitrous oxide-induced hypothermia in the rat

    SciTech Connect

    Quock, R.M.; Panek, R.W.; Kouchich, F.J.; Rosenthal, M.A.

    1987-08-10

    Exposure of rats to high levels of nitrous oxide (N2O) in oxygen reduced body temperature in a concentration-related manner. The hypothermia was partly reversed by pretreatment with naloxone but not naltrexone. But in rats rendered tolerant to morphine by pellet implantation, exposure to 75% N2O/25% O2 evoked a marked hypothermia similar to that observed in morphine-naive animals. In another experiment, the hypothermic effect of chloral hydrate was also sensitive to antagonism by pretreatment with naloxone but not naltrexone. These observations lead the authors to suspect that N2O-induced hypothermia in rats is possibly not mediated by opiate receptors. The thermotropic activity of N2O may result from some non-opioid action of N2O. Its selective antagonism by naloxone (but not naltrexone) may be due to a unique non-opioid analeptic action of naloxone. 32 references, 4 figures.

  7. Risk factors for infantile hypothermia in early neonatal life.

    PubMed

    Zabelle, J; Dagan, R; Neumann, L; Sofer, S

    1990-06-01

    Hypothermia in infancy is not uncommon among the low socioeconomic population in various parts of the world. It is prevalent in Israel and is associated with severe morbidity and mortality. We tried to identify neonates at risk among the population of the Negev district of Israel. Ninety-one infant hospitalized with infantile hypothermia (IH) during the years 1974 to 1981 were identified. The neonates belonged to two distinct ethnic groups, Bedouins and Jews, and were compared with 120 healthy controls of similar background. Our data show that premature infants and babies with low birth weight born during the cold season to young (inexperienced) mothers of lower socioeconomic strata and who sustained perinatal morbidity are at risk for IH. It is suggested that parents of infants at risk should be approached while the baby is till in the nursery, be advised about the possibility of hypothermia, and institute the appropriate preventive measures.

  8. Short- and Long-Term Outcomes in Very Low Birth Weight Infants with Admission Hypothermia

    PubMed Central

    Wang, Shwu-Meei; Lung, Hou-Ling; Chang, Jui-Hsing; Hsu, Chyong-Hsin; Jim, Wai-Tim; Lee, Ching-Hsiao; Hung, Hsiao-Fang

    2015-01-01

    Background Neonatal hypothermia remains a common problem and is related to elevated morbidities and mortality. However, the long-term neurodevelopmental effects of admission hypothermia are still unknown. This study attempted to determine the short-term and long-term consequences of admission hypothermia in VLBW preterm infants. Study Design This retrospective study measured the incidence and compared the outcomes of admission hypothermia in very low birth weight (VLBW) preterm infants in a tertiary-level neonatal intensive care unit. Infants were divided into the following groups: normothermia (36.5–37.5°C), mild hypothermia (36.0–36.4°C), moderate hypothermia (32.0–35.9°C), and severe hypothermia (< 32°C). We compared the distribution, demographic variables, short-term outcomes, and neurodevelopmental outcomes at 24 months of corrected age among groups. Results We studied 341 infants: 79 with normothermia, 100 with mild hypothermia, 162 with moderate hypothermia, and 0 with severe hypothermia. Patients in the moderate hypothermia group had significantly lower gestational ages (28.1 wk vs. 29.7 wk, P < .02) and smaller birth weight (1004 g vs. 1187 g, P < .001) compared to patients in the normothermia group. Compared to normothermic infants, moderately hypothermic infants had significantly higher incidences of 1-min Apgar score < 7 (63.6% vs. 31.6%, P < .001), respiratory distress syndrome (RDS) (58.0% vs. 39.2%, P = .006), and mortality (18.5% vs. 5.1%, P = .005). Moderate hypothermia did not affect neurodevelopmental outcomes at 2 years’ corrected age. Mild hypothermia had no effect on short-term or long-term outcomes. Conclusions Admission hypothermia was common in VLBW infants and correlated inversely with birth weight and gestational age. Although moderate hypothermia was associated with higher RDS and mortality rates, it may play a limited role among multifactorial causes of neurodevelopmental impairment. PMID:26193370

  9. Severe Cranioencephalic Trauma: Prehospital Care, Surgical Management and Multimodal Monitoring

    PubMed Central

    Moscote-Salazar, Luis Rafael; M. Rubiano, Andres; Alvis-Miranda, Hernando Raphael; Calderon-Miranda, Willem; Alcala-Cerra, Gabriel; Blancas Rivera, Marco Antonio; Agrawal, Amit

    2016-01-01

    Traumatic brain injury is a leading cause of death in developed countries. It is estimated that only in the United States about 100,000 people die annually in parallel among the survivors there is a significant number of people with disabilities with significant costs for the health system. It has been determined that after moderate and severe traumatic injury, brain parenchyma is affected by more than 55% of cases. Head trauma management is critical is the emergency services worldwide. We present a review of the literature regarding the prehospital care, surgical management and intensive care monitoring of the patients with severe cranioecephalic trauma.  PMID:27162922

  10. [Pre-hospital management of acute coronary syndrome].

    PubMed

    Lefort, Hugues; Fradin, Jordan; Blgnand, Michel; Tourtier, Jean-Pierre

    2015-03-01

    The medical management of acute coronary syndrome (ACS) follows the recommendations of international medical societies. The call to the emergency services by the patient triggers a race against the clock in pre-hospital care. It is essential to reduce the duration of the inadequate perfusion of the heart in order to limit its consequences. An effective reperfusion strategy must be planned in advance taking into account the logistical constraints. It is crucial that the general public is educated to recognise the signs of ACS and to call the emergency services immediately (such as 15, 112 or 991). PMID:26040140

  11. Osborn waves in the electrocardiogram, hypothermia not due to exposure, and death due to diabetic ketoacidosis.

    PubMed

    Sheikh, Abdul M; Hurst, J Willis

    2003-12-01

    Hypothermia usually occurs because a patient has been exposed to a cold environment; however, a number of nonenvironmental conditions may produce hypothermia. This report relates the clinical course of a patient whose hypothermia was due to severe diabetic ketoacidosis. In addition, we review the causes of hypothermia and Osborn waves beyond exposure to cold temperature. Hypothermia due to diabetic ketoacidosis is an uncommon complication of a common disease that carries with it clinically significant consequences. Accordingly, we believe that all clinicians should be aware of this potential complication of diabetic ketoacidosis and should be able to recognize the importance of the electrocardiogram in such patients. PMID:14677808

  12. Spontaneous periodic hypothermia and hyperhidrosis: a possibly novel cerebral neurotransmitter disorder.

    PubMed

    Rodrigues Masruha, Marcelo; Lin, Jaime; Arita, Juliana Harumi; De Castro Neto, Eduardo Ferreira; Scerni, Débora Amado; Cavalheiro, Esper Abrão; Mazzacoratti, Maria Da Graça Naffah; Vilanova, Luiz Celso Pereira

    2011-04-01

    Spontaneous periodic episodes of hypothermia still defy medical knowledge. In 1969, Shapiro et al. described the first two cases of spontaneous periodic hypothermia associated with agenesis of the corpus callosum. Recently, Dundar et al. reported a case of spontaneous periodic hypothermia and hyperhidrosis without corpus callosum agenesis, suggesting that the periodic episodes of hypothermia might be of epileptiform origin. Here we describe two paediatric patients with spontaneous periodic hypothermia without corpus callosum agenesis and demonstrate, to our knowledge for the first time, altered levels of neurotransmitter metabolites within the cerebrospinal fluid.

  13. Spontaneous periodic hypothermia and hyperhidrosis: a possibly novel cerebral neurotransmitter disorder.

    PubMed

    Rodrigues Masruha, Marcelo; Lin, Jaime; Arita, Juliana Harumi; De Castro Neto, Eduardo Ferreira; Scerni, Débora Amado; Cavalheiro, Esper Abrão; Mazzacoratti, Maria Da Graça Naffah; Vilanova, Luiz Celso Pereira

    2011-04-01

    Spontaneous periodic episodes of hypothermia still defy medical knowledge. In 1969, Shapiro et al. described the first two cases of spontaneous periodic hypothermia associated with agenesis of the corpus callosum. Recently, Dundar et al. reported a case of spontaneous periodic hypothermia and hyperhidrosis without corpus callosum agenesis, suggesting that the periodic episodes of hypothermia might be of epileptiform origin. Here we describe two paediatric patients with spontaneous periodic hypothermia without corpus callosum agenesis and demonstrate, to our knowledge for the first time, altered levels of neurotransmitter metabolites within the cerebrospinal fluid. PMID:21166673

  14. Would a prehospital practitioner model improve patient care in rural Australia?

    PubMed Central

    O'Meara, P

    2003-01-01

    Methods: Soft systems methodology was used to develop and critically appraise the prehospital practitioner model as an alternative to existing models. This approach started from the philosophical viewpoint that prehospital services should be patient centred. Soft systems methodology was used to structure the elements of prehospital systems and the relations between them into metaphors and pictures that could be analysed. Results: This analysis showed that the most powerful reason for advocating the prehospital practitioner model is that it places prehospital systems within a symbiotic relationship with the healthcare system. Unlike the existing emergency service models or the "chain of survival" model, it is an integrated system that provides a range of services at multiple points during the patient care cycle. Thus, the prehospital practitioner would have roles in the prevention of injury and illness, responding to emergencies, facilitating recovery, and planning future strategies for a healthy community. Conclusions: Implementing this new model would see the prehospital system using its available capacity more effectively to fulfill broader public health and primary care outreach roles than is currently the case. Patients would be referred or transported to the most appropriate and cost effective facility as part of a seamless system that provides patients with well organised and high quality care. PMID:12642545

  15. Palliative care and prehospital emergency medicine: analysis of a case series.

    PubMed

    Carron, Pierre-Nicolas; Dami, Fabrice; Diawara, Fatoumata; Hurst, Samia; Hugli, Olivier

    2014-11-01

    Palliative care, which is intended to keep patients at home as long as possible, is increasingly proposed for patients who live at home, with their family, or in retirement homes. Although their condition is expected to have a lethal evolution, the patients-or more often their families or entourages-are sometimes confronted with sudden situations of respiratory distress, convulsions, hemorrhage, coma, anxiety, or pain. Prehospital emergency services are therefore often confronted with palliative care situations, situations in which medical teams are not skilled and therefore frequently feel awkward.We conducted a retrospective study about cases of palliative care situations that were managed by prehospital emergency physicians (EPs) over a period of 8 months in 2012, in the urban region of Lausanne in the State of Vaud, Switzerland.The prehospital EPs managed 1586 prehospital emergencies during the study period. We report 4 situations of respiratory distress or neurological disorders in advanced cancer patients, highlighting end-of-life and palliative care situations that may be encountered by prehospital emergency services.The similarity of the cases, the reasons leading to the involvement of prehospital EPs, and the ethical dilemma illustrated by these situations are discussed. These situations highlight the need for more formal education in palliative care for EPs and prehospital emergency teams, and the need to fully communicate the planning and implementation of palliative care with patients and patients' family members.

  16. [Research progress in mild hypothermia treatment of neonatal hypoxic-ischemic encephalopathy].

    PubMed

    Zhang, Peng; Cheng, Guo-Qiang

    2013-10-01

    Randomized controlled trials have demonstrated the safety and efficacy of mild hypothermia in the treatment of neonatal hypoxic-ischemic encephalopathy (HIE), which can reduce mortality or the incidence of severe neurological sequelae. Mild hypothermia has been used in the neonatal intensive care unit (NICU) as a routine treatment method for neonatal HIE in many developed countries, and it is increasingly applied in some NICUs in China. However, 40%-50% of the neonates treated with mild hypothermia die or develop severe neurological disability. Thus, to achieve the best neuroprotective effect, issues such as selection of patients with indications for mild hypothermia, cooling method, optimal time for mild hypothermia, duration of mild hypothermia, optimal target temperature, and the safety and long-term effects of mild hypothermia combined with other therapies, need to be further discussed. This article reviews the latest progress in clinical research on these issues.

  17. Effect of ultra-fast mild hypothermia using total liquid ventilation on hemodynamics and respiratory mechanics.

    PubMed

    Sage, Michaël; Nadeau, Mathieu; Kohlhauer, Matthias; Praud, Jean-Paul; Tissier, Renaud; Robert, Raymond; Walti, Hervé; Micheau, Philippe

    2016-08-01

    Ultra-fast cooling for mild therapeutic hypothermia (MTH) has several potential applications, including prevention of post-cardiac arrest syndrome. Ultra-fast MTH by total liquid ventilation (TLV) entails the sudden filling of the lungs with a cold perfluorocarbon liquid and its subsequent use to perform TLV. The present physiological study was aimed at assessing whether pulmonary and systemic hemodynamics as well as lung mechanics are significantly altered during this procedure. Pulmonary and systemic arterial pressures, cardiac output as well as airway resistance and respiratory system compliance were measured during ultra-fast MTH by TLV followed by rewarming and normothermia in six healthy juvenile lambs. Results show that none of the studied variables were altered upon varying the perfluorocarbon temperature from 12 to 41 °C. It is concluded that ultra-fast MTH by TLV does not have any deleterious effect on hemodynamics or lung mechanics in healthy juvenile lambs.

  18. Impaired cerebral autoregulation and brain injury in newborns with hypoxic-ischemic encephalopathy treated with hypothermia.

    PubMed

    Massaro, An N; Govindan, R B; Vezina, Gilbert; Chang, Taeun; Andescavage, Nickie N; Wang, Yunfei; Al-Shargabi, Tareq; Metzler, Marina; Harris, Kari; du Plessis, Adre J

    2015-08-01

    Impaired cerebral autoregulation may contribute to secondary injury in newborns with hypoxic-ischemic encephalopathy (HIE). Continuous, noninvasive assessment of cerebral pressure autoregulation can be achieved with bedside near-infrared spectroscopy (NIRS) and systemic mean arterial blood pressure (MAP) monitoring. This study aimed to evaluate whether impaired cerebral autoregulation measured by NIRS-MAP monitoring during therapeutic hypothermia and rewarming relates to outcome in 36 newborns with HIE. Spectral coherence analysis between NIRS and MAP was used to quantify changes in the duration [pressure passivity index (PPI)] and magnitude (gain) of cerebral autoregulatory impairment. Higher PPI in both cerebral hemispheres and gain in the right hemisphere were associated with neonatal adverse outcomes [death or detectable brain injury by magnetic resonance imaging (MRI), P < 0.001]. NIRS-MAP monitoring of cerebral autoregulation can provide an ongoing physiological biomarker that may help direct care in perinatal brain injury.

  19. Impaired cerebral autoregulation and brain injury in newborns with hypoxic-ischemic encephalopathy treated with hypothermia.

    PubMed

    Massaro, An N; Govindan, R B; Vezina, Gilbert; Chang, Taeun; Andescavage, Nickie N; Wang, Yunfei; Al-Shargabi, Tareq; Metzler, Marina; Harris, Kari; du Plessis, Adre J

    2015-08-01

    Impaired cerebral autoregulation may contribute to secondary injury in newborns with hypoxic-ischemic encephalopathy (HIE). Continuous, noninvasive assessment of cerebral pressure autoregulation can be achieved with bedside near-infrared spectroscopy (NIRS) and systemic mean arterial blood pressure (MAP) monitoring. This study aimed to evaluate whether impaired cerebral autoregulation measured by NIRS-MAP monitoring during therapeutic hypothermia and rewarming relates to outcome in 36 newborns with HIE. Spectral coherence analysis between NIRS and MAP was used to quantify changes in the duration [pressure passivity index (PPI)] and magnitude (gain) of cerebral autoregulatory impairment. Higher PPI in both cerebral hemispheres and gain in the right hemisphere were associated with neonatal adverse outcomes [death or detectable brain injury by magnetic resonance imaging (MRI), P < 0.001]. NIRS-MAP monitoring of cerebral autoregulation can provide an ongoing physiological biomarker that may help direct care in perinatal brain injury. PMID:26063779

  20. Wireless local area network in a prehospital environment

    PubMed Central

    Chen, Dongquan; Soong, Seng-jaw; Grimes, Gary J; Orthner, Helmuth F

    2004-01-01

    Background Wireless local area networks (WLANs) are considered the next generation of clinical data network. They open the possibility for capturing clinical data in a prehospital setting (e.g., a patient's home) using various devices, such as personal digital assistants, laptops, digital electrocardiogram (EKG) machines, and even cellular phones, and transmitting the captured data to a physician or hospital. The transmission rate is crucial to the applicability of the technology in the prehospital setting. Methods We created two separate WLANs to simulate a virtual local are network environment such as in a patient's home or an emergency room (ER). The effects of different methods of data transmission, number of clients, and roaming among different access points on the file transfer rate were determined. Results The present results suggest that it is feasible to transfer small files such as patient demographics and EKG data from the patient's home to the ER at a reasonable speed. Encryption, user control, and access control were implemented and results discussed. Conclusions Implementing a WLAN in a centrally managed and multiple-layer-controlled access control server is the key to ensuring its security and accessibility. Future studies should focus on product capacity, speed, compatibility, interoperability, and security management. PMID:15339336

  1. The Social Epidemiology of Accidental Hypothermia among the Aged.

    ERIC Educational Resources Information Center

    Rango, Nicholas

    1985-01-01

    Describes the 1970-1979 incidence of exposure-related hypothermia deaths in the United States. Showed nonwhite men at highest and white women at lowest risk at all ages. Age-related impairment in theromoregulation, functional disability, poverty, and social isolation were found to increase elderly individual's susceptibility to this environmental…

  2. Hypothermia in bleeding trauma: a friend or a foe?

    PubMed Central

    2009-01-01

    The induction of hypothermia for cellular protection is well established in several clinical settings. Its role in trauma patients, however, is controversial. This review discusses the benefits and complications of induced hypothermia--emphasizing the current state of knowledge and potential applications in bleeding patients. Extensive pre-clinical data suggest that in advanced stages of shock, rapid cooling can protect cells during ischemia and reperfusion, decrease organ damage, and improve survival. Yet hypothermia is a double edged sword; unless carefully managed, its induction can be associated with a number of complications. Appropriate patient selection requires a thorough understanding of the pre-clinical literature. Clinicians must also appreciate the enormous influence that temperature modulation exerts on various cellular mechanisms. This manuscript aims to provide a balanced view of the published literature on this topic. While many of the advantageous molecular and physiological effects of induced hypothermia have been outlined in animal models, rigorous clinical investigations are needed to translate these promising findings into clinical practice. PMID:20030810

  3. "Terminal burrowing behaviour"--a phenomenon of lethal hypothermia.

    PubMed

    Rothschild, M A; Schneider, V

    1995-01-01

    Between 1978 and 1994, 69 cases of death due to lethal hypothermia were examined in our Institute. In addition to the common findings associated with hypothermia we especially wanted to examine the so-called paradox reaction which refers to the undressing of persons in a state of severe (lethal) hypothermia. This is obviously the result of a peripheral vasodilatation effecting a feeling of warmth. In our material this paradoxical undressing occurred in 25% of the cases and nearly all exhibited an additional phenomenon which has not yet been described in the literature. Nearly all bodies with partial or complete disrobement were found in a position which indicated a final mechanism of protection i.e. under a bed, behind a wardrobe, in a shelf etc.. This is obviously an autonomous process of the brain stem, which is triggered in the final state of hypothermia and produces a primitive and burrowing-like behaviour of protection, as seen in (hibernating) animals. This phenomenon, which we refer to as "terminal burrowing behaviour", occurred predominantly with slow decreases in temperature and moderately cold conditions. PMID:7632602

  4. Prevention and Management of Neonatal Hypothermia in Rural Zambia

    PubMed Central

    Lunze, Karsten; Yeboah-Antwi, Kojo; Marsh, David R.; Kafwanda, Sarah Ngolofwana; Musso, Austen; Semrau, Katherine; Waltensperger, Karen Z.; Hamer, Davidson H.

    2014-01-01

    Background Neonatal hypothermia is increasingly recognized as a risk factor for newborn survival. The World Health Organization recommends maintaining a warm chain and skin-to-skin care for thermoprotection of newborn children. Since little is known about practices related to newborn hypothermia in rural Africa, this study's goal was to characterize relevant practices, attitudes, and beliefs in rural Zambia. Methods and Findings We conducted 14 focus group discussions with mothers and grandmothers and 31 in-depth interviews with community leaders and health officers in Lufwanyama District, a rural area in the Copperbelt Province, Zambia, enrolling a total of 171 participants. We analyzed data using domain analysis. In rural Lufwanyama, community members were aware of the danger of neonatal hypothermia. Caregivers' and health workers' knowledge of thermoprotective practices included birthplace warming, drying and wrapping of the newborn, delayed bathing, and immediate and exclusive breastfeeding. However, this warm chain was not consistently maintained in the first hours postpartum, when newborns are at greatest risk. Skin-to-skin care was not practiced in the study area. Having to assume household and agricultural labor responsibilities in the immediate postnatal period was a challenge for mothers to provide continuous thermal care to their newborns. Conclusions Understanding and addressing community-based practices on hypothermia prevention and management might help improve newborn survival in resource-limited settings. Possible interventions include the implementation of skin-to-skin care in rural areas and the use of appropriate, low-cost newborn warmers to prevent hypothermia and support families in their provision of newborn thermal protection. Training family members to support mothers in the provision of thermoprotection for their newborns could facilitate these practices. PMID:24714630

  5. Comparison of Fentanyl and Morphine in the Prehospital Treatment of Ischemic Type Chest Pain.

    PubMed

    Weldon, Erin R; Ariano, Robert E; Grierson, Robert A

    2016-01-01

    In the treatment of acute coronary syndromes, reduction of sympathetic stress and catecholamine release is an important therapeutic goal. One method used to achieve this goal is pain reduction through the systemic administration of analgesia. Historically, morphine has been the analgesic of choice in ischemic cardiac pain. This randomized double-blind controlled trial seeks to prove the utility of fentanyl as an alternate first-line analgesic for ischemic-type chest pain in the prehospital setting. Successive patients who were treated for suspected ischemic chest pain in the emergency medical services system were considered eligible. Once chest pain was confirmed, patients received oxygen, aspirin, and nitroglycerin therapy. If the ischemic-type chest pain continued the patient was randomized in a double-blinded fashion to treatment with either morphine or fentanyl. Pain scale scores, necessity for additional dosing, and rate of adverse events between the groups were assessed every 5 minutes and were compared using t-testing, Fisher's Exact test, or Analysis of Variance (ANOVA) where appropriate. The primary outcome of the study was incidence of hypotension and the secondary outcome was pain reduction as measured by the visual analog score and numeric rating score. A total of 207 patients were randomized with 187 patients included in the final analysis. Of the 187 patients, 99 were in the morphine group and 88 in the fentanyl group. No statistically significant difference between the two groups with respect to hypotension was found (morphine 5.1% vs. fentanyl 0%, p = 0.06). Baseline characteristics, necessity for additional dosing, and other adverse events between the two groups were not statistically different. There were no significant differences between the changes in visual analog scores and numeric rating scale scores for pain between the two groups (p = 0.16 and p = 0.15, respectively). This study supports that fentanyl and morphine are comparable in

  6. Protective effects of moderate hypothermia on behavioral deficits but not necrotic cavitation following cortical impact injury in the rat.

    PubMed

    Dixon, C E; Markgraf, C G; Angileri, F; Pike, B R; Wolfson, B; Newcomb, J K; Bismar, M M; Blanco, A J; Clifton, G L; Hayes, R L

    1998-02-01

    A number of experimental studies have reported that moderate hypothermia can produce significant protection against behavioral deficits and/or morphopathological alterations following traumatic brain injury; a Phase 3 clinical trial is currently examining the therapeutic potential for moderate hypothermia (32 degrees C) to improve outcome following severe traumatic brain injury in humans. The current study examined whether hypothermia (32 degrees C) provided behavioral protection following experimental cortical impact injury. The extent of focal cortical contusion was also examined in the same rats. A total of 30 male Sprague-Dawley rats were trained on beam balance and beam walking tasks prior to injury. Under isoflurane anesthesia, cortical impact was produced on the right parietal cortex of 20 rats. Ten rats underwent all surgical procedures but were not impacted (sham-injured rats). Ten of the injured rats were cooled to 32 degrees C (measured in temporalis muscle) beginning 5 min postinjury, maintained for 2 h and rewarmed slowly for 1 h. In the other 10 injured rats, normothermic temperatures (37.5 degrees C) were maintained for the same duration. Beam balance and beam walking performance was assessed daily for 5 days following injury. At 11 days postinjury, rats were assessed for 5 days on acquisition of the Morris water maze task. Following behavioral assessments, rats were perfused and the brain removed. Coronal sections were cut through the site of cortical impact injury and stained with hematoxylin and eosin. Hypothermic treatment resulted in significantly less beam balance and beam walking deficits than observed in normothermic rats. Hypothermia also significantly attenuated spatial memory performance deficits. Quantitative morphometric analyses failed to detect any significant differences in volumes of necrotic tissue cavitation in cortices of hypothermic and normothermic rats. Hypothermic treatment also had no effect on volumes of dorsal hippocampal

  7. Prehospitalization Preparation for Institutionalized People with Mental Retardation: A Nursing Approach.

    ERIC Educational Resources Information Center

    Murphy, Diane M.

    1986-01-01

    A program developed by the nursing department at Fernald State School (Massachusetts) prepares nurses to develop prehospital admission teaching programs for mentally retarded persons. Two case studies indicate that the program's emphasis on an interdisciplinary team approach is successful. (CB)

  8. Prolonged Local Hypothermia Has No Long-Term Adverse Effect on the Spinal Cord

    PubMed Central

    Vipin, Ashwati; Kortelainen, Jukka; Al-Nashash, Hasan; Chua, Soo Min; Thow, Xinyuan; Manivannan, Janani; Astrid; Thakor, Nitish V.; Kerr, Candace L.

    2015-01-01

    Hypothermia is known to be neuroprotective and is one of the most effective and promising first-line treatments for central nervous system (CNS) trauma. At present, induction of local hypothermia, as opposed to general hypothermia, is more desired because of its ease of application and safety; fewer side effects and an absence of severe complications have been noted. Local hypothermia involves temperature reduction of a small and specific segment of the spinal cord. Our group has previously shown the neuroprotective effect of short-term, acute moderate general hypothermia through improvements in electrophysiological and motor behavioral assessments, as well as histological examination following contusive spinal cord injury (SCI) in rats. We have also shown the benefit of using short-term local hypothermia versus short-term general hypothermia post-acute SCI. The overall neuroprotective benefit of hypothermia can be categorized into three main components: (1) induction modality, general versus local, (2) invasive, semi-invasive or noninvasive, and (3) duration of hypothermia induction. In this study, a series of experiments were designed to investigate the feasibility, long-term safety, as well as eventual complications and side effects of prolonged, semi-invasive, moderate local hypothermia (30°C±0.5°C for 5 and 8 hours) in rats with uninjured spinal cord while maintaining their core temperature at 37°C±0.5°C. The weekly somatosensory evoked potential and motor behavioral (Basso, Beattie and Bresnahan) assessments of rats that underwent 5 and 8 hours of semi-invasive local hypothermia, which revealed no statistically significant changes in electrical conductivity and behavioral outcomes. In addition, 4 weeks after local hypothermia induction, histological examination showed no anatomical damages or morphological changes in their spinal cord structure and parenchyma. We concluded that this method of prolonged local hypothermia is feasible, safe, and has the

  9. The Swiss bus accident on 13 March 2012: lessons for pre-hospital care.

    PubMed

    Lyon, Richard M; Sanders, Jon

    2012-07-11

    The recent bus crash in Switzerland involving many children provides several lessons for the pre-hospital care community. The use of multiple helicopters that are capable of flying at night and that carry advanced medical pre-hospital teams undoubtedly saved lives following the tragedy. We describe the medical response to the incident and the lessons that can be learned for emergency medical services.

  10. Migrants' and professionals' views on culturally sensitive pre-hospital emergency care.

    PubMed

    Kietzmann, Diana; Hannig, Christian; Schmidt, Silke

    2015-08-01

    This study was designed to explore the views of migrants and professionals on culturally sensitive pre-hospital emergency care in order to adapt such care to migrants' needs. Interviews were conducted with 41 migrants who had received direct (as a patient) or indirect (as a significant other) pre-hospital emergency care. Furthermore, 20 professionals in the field of pre-hospital emergency care were interviewed. The content analysis showed five distinguishable categories based on the statements by the migrants and six categories based on the statements by the professionals. While migrants gave priority to basic proficiencies of first responders such as 'social/emotional competencies' and 'communication skills', the professionals considered '(basic) cultural knowledge', 'awareness' and 'attitude' the most important. Furthermore, migrants provided practical indications, e.g. regarding areas of cultural knowledge, whereas professionals seemed to view the issue of culturally pre-hospital emergency care from a more theoretical perspective. The issues of the culturally sensitive pre-hospital emergency care itself, as well as the varying points of view of the two groups interviewed, resulted in eight recommendations for culturally sensitive pre-hospital emergency care. PMID:26123882

  11. Migrants' and professionals' views on culturally sensitive pre-hospital emergency care.

    PubMed

    Kietzmann, Diana; Hannig, Christian; Schmidt, Silke

    2015-08-01

    This study was designed to explore the views of migrants and professionals on culturally sensitive pre-hospital emergency care in order to adapt such care to migrants' needs. Interviews were conducted with 41 migrants who had received direct (as a patient) or indirect (as a significant other) pre-hospital emergency care. Furthermore, 20 professionals in the field of pre-hospital emergency care were interviewed. The content analysis showed five distinguishable categories based on the statements by the migrants and six categories based on the statements by the professionals. While migrants gave priority to basic proficiencies of first responders such as 'social/emotional competencies' and 'communication skills', the professionals considered '(basic) cultural knowledge', 'awareness' and 'attitude' the most important. Furthermore, migrants provided practical indications, e.g. regarding areas of cultural knowledge, whereas professionals seemed to view the issue of culturally pre-hospital emergency care from a more theoretical perspective. The issues of the culturally sensitive pre-hospital emergency care itself, as well as the varying points of view of the two groups interviewed, resulted in eight recommendations for culturally sensitive pre-hospital emergency care.

  12. Identification of adults with sepsis in the prehospital environment: a systematic review

    PubMed Central

    Smyth, Michael A; Brace-McDonnell, Samantha J; Perkins, Gavin D

    2016-01-01

    Objective Early identification of sepsis could enable prompt delivery of key interventions such as fluid resuscitation and antibiotic administration which, in turn, may lead to improved patient outcomes. Limited data indicate that recognition of sepsis by paramedics is often poor. We systematically reviewed the literature on prehospital sepsis screening tools to determine whether they improved sepsis recognition. Design Systematic review. The electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed were systematically searched up to June 2015. In addition, subject experts were contacted. Setting Prehospital/emergency medical services (EMS). Study selection All studies addressing identification of sepsis (including severe sepsis and septic shock) among adult patients managed by EMS. Outcome measures Recognition of sepsis by EMS clinicians. Results Owing to considerable variation in the methodological approach adopted and outcome measures reported, a narrative approach to data synthesis was adopted. Three studies addressed development of prehospital sepsis screening tools. Six studies addressed paramedic diagnosis of sepsis with or without use of a prehospital sepsis screening tool. Conclusions Recognition of sepsis by ambulance clinicians is poor. The use of screening tools, based on the Surviving Sepsis Campaign diagnostic criteria, improves prehospital sepsis recognition. Screening tools derived from EMS data have been developed, but they have not yet been validated in clinical practice. There is a need to undertake validation studies to determine whether prehospital sepsis screening tools confer any clinical benefit. PMID:27496231

  13. Helium-cold induced hypothermia in the white rat.

    NASA Technical Reports Server (NTRS)

    Musacchia, X. J.; Jacobs, M.

    1973-01-01

    Hypothermia was induced in white rats by exposing them to low ambient temperatures (about 0 C) and a gaseous atmosphere of 80% helium and 20% oxygen (helox). Biological survival, in which revival from hypothermia to normothermia is achieved, and clinical survival, in which one or more functional attributes are monitored in the hypothermic animal until it dies, are examined. The helium-cold method appears to produce a hypothermic state in the rat quite similar to that resulting from such techniques as ice water immersion or hypercapnia + hypoxia. There is a direct relationship between body weight and percent survival. Despite the fact that they require a longer period to become hypothermic, the heavier animals are better able to survive.

  14. Accidental hypothermia and death from cold in urban areas

    NASA Astrophysics Data System (ADS)

    Tanaka, Masatoshi; Tokudome, Shogo

    1991-12-01

    Hypothermia is considered a sericus problem in big cities. In order to clarify factors contributing to urban hypothermia and death from cold which will continue to be an issue in cities in the future, we analyzed autopsy reports recorded in the Tokyo Medical Examiner's Office from 1974 to 1983. In a total of 18346 autopsy reports 157 deaths had been diagnosed as due to exposure to cold. Of these cases, the greatest number were males in their forties and fifties, and most of these were inebriated and/or homeless. Eighty-four perent of urban hypothermia cases occurred when the outdoor temperature was below 5°C, and 50% of deaths from cold occurred when the outdoor temperature was between 0° and 5°C. There were no incidences of death from cold when the minimum outdoor temperature had remained above 16°C. Seventy-four percent of deaths from cold occurred during the winter months of December, January and February, and most of the remaining deaths occurred in March and November. There were no deaths from cold from June to August. More than half of all deaths from cold occurred from 3.00 a.m. to 9.00 a.m., with the peak occurring at 5.00 a.m. A blood alcohol concentration of over 2.5 mg/ml had often been found in those in their forties and fifties who had died from hypothermia, and autopsy had often revealed disorders of the liver, digestive system, and circulatory system. Chronic lesions of the liver, probably due to alcoholism, were found in many cases; few cases showed no evidence of alcoholism and these were significantly different from the former group.

  15. Study on Control of Brain Temperature for Brain Hypothermia Treatment

    NASA Astrophysics Data System (ADS)

    Gaohua, Lu; Wakamatsu, Hidetoshi

    The brain hypothermia treatment is an attractive therapy for the neurologist because of its neuroprotection in hypoxic-ischemic encephalopathy patients. The present paper deals with the possibility of controlling the brain and other viscera in different temperatures from the viewpoint of system control. It is theoretically attempted to realize the special brain hypothermia treatment to cool only the head but to warm the body by using the simple apparatus such as the cooling cap, muffler and warming blanket. For this purpose, a biothermal system concerning the temperature difference between the brain and the other thoracico-abdominal viscus is synthesized from the biothermal model of hypothermic patient. The output controllability and the asymptotic stability of the system are examined on the basis of its structure. Then, the maximum temperature difference to be realized is shown dependent on the temperature range of the apparatus and also on the maximum gain determined from the coefficient matrices A, B and C of the biothermal system. Its theoretical analysis shows the realization of difference of about 2.5°C, if there is absolutely no constraint of the temperatures of the cooling cap, muffler and blanket. It is, however, physically unavailable. Those are shown by simulation example of the optimal brain temperature regulation using a standard adult database. It is thus concluded that the surface cooling and warming apparatus do no make it possible to realize the special brain hypothermia treatment, because the brain temperature cannot be cooled lower than those of other viscera in an appropriate temperature environment. This study shows that the ever-proposed good method of clinical treatment is in principle impossible in the actual brain hypothermia treatment.

  16. RUC-4: A Novel αIIbβ3 Antagonist for Pre-hospital Therapy of Myocardial Infarction

    PubMed Central

    Li, Jihong; Vootukuri, Spandana; Shang, Yi; Negri, Ana; Jiang, Jian-kang; Nedelman, Mark; Diacovo, Thomas G.; Filizola, Marta; Thomas, Craig J.; Coller, Barry S.

    2014-01-01

    Objective Treatment of myocardial infarction (MI) within the first 1–2 hours with a thrombolytic agent, percutaneous coronary intervention, or an αIIbβ3 antagonist decreases mortality and the later development of heart failure. We previously reported on a novel small molecule αIIbβ3 antagonist, RUC-2, that has a unique mechanism of action. We have now developed a more potent and more soluble congener of RUC-2, RUC-4, designed to be easily administered intramuscularly (IM) by autoinjector to facilitate its use in the pre-hospital setting. Here we report the properties of RUC-4 and the antiplatelet and antithrombotic effects of RUC-2 and RUC-4 in animal models. Approach and Results RUC-4 was ~20% more potent than RUC-2 in inhibiting human ADP-induced platelet aggregation and much more soluble in aqueous solutions (60–80 mg/ml). It shared RUC-2’s specificity for αIIbβ3 vs αVβ3, did not prime the receptor to bind fibrinogen, or induce changes in β3 identified by a conformation-specific monoclonal antibody. Both RUC-2 and RUC-4 prevented FeCl3-induced thrombotic occlusion of the carotid artery in mice and decreased microvascular thrombi in response to laser injury produced by human platelets infused into transgenic mice containing a mutated von Willebrand factor that reacts with human, but not mouse platelets. IM injection of RUC-4 in non-human primates at 1.9 and 3.85 mg/kg led to complete inhibition of platelet aggregation within 15 minutes, with dose-dependent return of platelet aggregation after 4.5–24 hours. Conclusions RUC-4 has favorable biochemical, pharmacokinetic, pharmacodynamic, antithrombotic, and solubility properties as a pre-hospital therapy of MI, but the possibility of increased bleeding with therapeutic doses remains to be evaluated. PMID:25147334

  17. Histological and immunohistochemical study of Wischnewsky spots in fatal hypothermia.

    PubMed

    Tsokos, Michael; Rothschild, Markus A; Madea, Burkhard; Rie, Manfred; Sperhake, Jan P

    2006-03-01

    Wischnewsky spots in the gastric mucosa are considered an important finding for the diagnosis of hypothermia-related deaths. In the present prospective histological and immunohistochemical investigation, 14 cases of fatal hypothermia presenting Wischnewsky spots at autopsy were studied. Macromorphologically, the lesions, varying in diameter from 0.1 to 0.4 cm, had a blackish-brownish color and appeared partly lofty, especially on the apex of gastric folds. Histologically, no erosions or ulcers were observed in the gastric mucosa. In some cases, hemorrhages in conjunction with infarctions of the mucosa were observed in the mucosal glands. Those regions, however, did not represent the lesions visible as Wischnewsky spots at the macroscopical level. Immunohistochemical stains were done with a specific antibody against hemoglobin (Dako, Glostrup, Denmark). Wischnewsky spots expressed immunopositivity with antihemoglobin. Concerning the pathogenesis and underlying pathophysiologic mechanisms contributing to the development of Wischnewsky spots, we hypothesize that cooling of the body in the setting of cold ambient temperatures primarily leads to circumscribed hemorrhages of the gastric glands in vivo or in the agonal period, respectively. Subsequently, due to autolysis, erythrocytes are destroyed and hemoglobin is released. Following exposure to gastric acid, hemoglobin is hematinized, leading to the typical blackish-brownish appearance of Wischnewsky spots seen at gross examination. Wischnewsky spots are not equivalent to erosions in terms of histopathological diagnosis but rather represent epiphenomena generated in vivo or in the agonal period of fatal hypothermia. PMID:16501354

  18. Protective Mechanisms of Hypothermia in Liver Surgery and Transplantation

    PubMed Central

    Olthof, Pim B; Reiniers, Megan J; Dirkes, Marcel C; van Gulik, Thomas M; Heger, Michal; van Golen, Rowan F

    2015-01-01

    Hepatic ischemia/reperfusion (I/R) injury is a side effect of major liver surgery that often cannot be avoided. Prolonged periods of ischemia put a metabolic strain on hepatocytes and limit the tolerable ischemia and preservation times during liver resection and transplantation, respectively. In both surgical settings, temporarily lowering the metabolic demand of the organ by reducing organ temperature effectively counteracts the negative consequences of an ischemic insult. Despite its routine use, the application of liver cooling is predicated on an incomplete understanding of the underlying protective mechanisms, which has limited a uniform and widespread implementation of liver-cooling techniques. This review therefore addresses how hypothermia-induced hypometabolism modulates hepatocyte metabolism during ischemia and thereby reduces hepatic I/R injury. The mechanisms underlying hypothermia-mediated reduction in energy expenditure during ischemia and the attenuation of mitochondrial production of reactive oxygen species during early reperfusion are described. It is further addressed how hypothermia suppresses the sterile hepatic I/R immune response and preserves the metabolic functionality of hepatocytes. Lastly, a summary of the clinical status quo of the use of liver cooling for liver resection and transplantation is provided. PMID:26552060

  19. Plasma levels of liver-specific miR-122 is massively increased in a porcine cardiogenic shock model and attenuated by hypothermia.

    PubMed

    Andersson, Patrik; Gidlöf, Olof; Braun, Oscar O; Götberg, Matthias; van der Pals, Jesper; Olde, Björn; Erlinge, David

    2012-02-01

    Tissue-specific circulating micro-RNAs (miRNAs) are released into the blood after organ injury. In an ischemic porcine cardiogenic shock model, we investigated the release pattern of cardiac-specific miR-208b and liver-specific miR-122 and assessed the effect of therapeutic hypothermia on their respective plasma levels. Pigs were anesthetized, and cardiogenic shock was induced by inflation of a percutaneous coronary intervention balloon in the proximal left anterior descending artery for 40 min followed by reperfusion. After fulfillment of the predefined shock criteria, the pigs were randomized to hypothermia (33°C, n = 6) or normothermia (38°C, n = 6). Circulating miRNAs were extracted from plasma and measured with quantitative real-time polymerase chain reaction (PCR). Tissue specificity was assessed by miRNA extraction from porcine tissues followed by quantitative real-time PCR. In vitro, the release of miR-122 from a cultured hepatocyte cell line exposed to either hypoxia or acidosis was assessed by real-time PCR. miR-122 was found to be highly liver specific, whereas miR-208b was expressed exclusively in the heart. In the control group, ischemic cardiogenic shock induced a 460,000-fold and a 63,000-fold increase in plasma levels of miR-122 (P < 0.05) and miR-208b (P < 0.05), respectively. Therapeutic hypothermia significantly diminished the increase in miR-122 compared with the normothermic group (P < 0.005). In our model, hypothermia was initiated after coronary reperfusion and did not affect either myocardial damage as previously assessed by magnetic resonance imaging or the plasma level of miR-208b. Our results indicate that liver-specific miR-122 is released into the circulation in the setting of cardiogenic shock and that therapeutic hypothermia significantly reduces the levels of miR-122.

  20. The geography of hypothermia in the United States: An analysis of mortality, morbidity, thresholds, and messaging

    NASA Astrophysics Data System (ADS)

    Spencer, Jeremy M.

    Hypothermia within the United States has seldom been studied from a geographic perspective. This dissertation assessed the following aspects of hypothermia: 1) A cataloging of Internet web pages containing hypothermia-related guidance, with a summary of the information contained within. The summarized hypothermia information was assessed for scientific validity through an extensive assessment of the peer-reviewed medical literature; 2) the spatio-temporal distribution of hypothermia deaths in U.S. Combined Statistical areas for the years 1979-2004, and their association with National Weather Service windchill advisory and warning thresholds; 3) the spatio-temporal distribution of hypothermia morbidity in the State of New York from 1991-1992 to 2005-2006 and its association with Spatial Synoptic Classification weather types. The results indicate that web-based hypothermia information has generally poor content not supported by the scientific literature, and there are many prominent omissions of well-established hypothermia information. A total of 9,185 hypothermia fatalities attributable to cold exposure occurred in 89 metro areas from 1979 to 2004. The southeastern US had the greatest vulnerability to hypothermia, with high rates of deaths occurring at higher temperatures than northern states. Median windchill temperature associated with deaths was generally latitudinal, with southern deaths occurring at higher temperatures. For all regions, hypothermia deaths occurred at temperatures considerably higher than windchill advisory criteria. Hypothermia morbidity within New York State was associated with long-lasting polar weather types. There are a number of findings common to these three papers. Information about hypothermia tends to be under-communicated (no central location for wind chill alerts, unsupported statements on many websites). Hypothermia deaths and hospitalizations increase when locally cold and long-lasting weather types occur, which fits in with what

  1. Spontaneous hypothermia in human sepsis is a transient, self-limiting, and nonterminal response.

    PubMed

    Fonseca, Monique T; Rodrigues, Abner C; Cezar, Luana C; Fujita, Andre; Soriano, Francisco G; Steiner, Alexandre A

    2016-06-15

    Hypothermia in sepsis is generally perceived as something dysregulated and progressive although there has been no assessment on the natural course of this phenomenon in humans. This was the first study on the dynamics of hypothermia in septic patients not subjected to active rewarming, and the results were surprising. A sample of 50 subjects presenting with spontaneous hypothermia during sepsis was drawn from the 2005-2012 database of an academic hospital. Hypothermia was defined as body temperature below 36.0°C for longer than 2 h, with at least one reading of 35.5°C or less. The patients presented with 138 episodes of hypothermia, 21 at the time of the sepsis diagnosis and 117 with a later onset. However, hypothermia was uncommon in the final 12 h of life of the patients that succumbed. The majority (97.1%) of the hypothermic episodes were transient and self-limited; the median recovery time was 6 h; body temperature rarely fell below 34.0°C. Bidirectional oscillations in body temperature were evident in the course of hypothermia. Nearly half of the hypothermic episodes had onset in the absence of shock or respiratory distress, and the incidence of hypothermia was not increased during either of these conditions. Usage of antipyretic drugs, sedatives, neuroleptics, or other medications did not predict the onset of hypothermia. In conclusion, hypothermia appears to be a predominantly transient, self-limiting, and nonterminal phenomenon that is inherent to human sepsis. These characteristics resemble those of the regulated hypothermia shown to replace fever in animal models of severe systemic inflammation.

  2. Fasting triggers hypothermia, and ambient temperature modulates its depth in Japanese quail Coturnix japonica.

    PubMed

    Ben-Hamo, Miriam; Pinshow, Berry; McCue, Marshall D; McWilliams, Scott R; Bauchinger, Ulf

    2010-05-01

    We tested three hypotheses regarding the cues that elicit facultative hypothermia in Japanese quail (Coturnix japonica): H(1)) Ambient temperature (T(a)), alone, influences the onset and depth of hypothermia; H(2)) Fasting, alone, influences the onset and depth of hypothermia; H(3)) T(a) acts synergistically with fasting to shape the use of hypothermia. Eight quail were maintained within their thermoneutral zone (TNZ) at 32.6+/-0.2 degrees C, and eight below their lower critical temperature (T(lc)) at 12.7+/-3.0 degrees C. All quail entered hypothermia upon food deprivation, even quail kept within their TNZ. Body temperature (T(b)) decreased more (38.36+/-0.53 degrees C vs. 39.57+/-0.57 degrees C), body mass (m(b)) loss was greater (21.0+/-7.20 g vs.12.8+/-2.62g), and the energy saved by using hypothermia was greater (25.18-45.01% vs. 7.98-28.06%) in low the T(a) treatment than in TNZ treatment. Interestingly, the depth of hypothermia was positively correlated with m(b) loss in the low T(a) treatment, but not in TNZ treatment. Our data support H(3), that both thermoregulatory costs and body energy reserves are proximate cues for entry into hypothermia in quail. This outcome is not surprising below the T(lc). However, the quail kept at their TNZ also responded to food deprivation by entering hypothermia with no apparent dependence on m(b) loss. Therefore inputs, other than thermoregulatory costs and body condition, must serve as cues to enter hypothermia. Consequently, we address the role that tissue sparing may play in the physiological 'decision' to employ hypothermia.

  3. Spontaneous hypothermia in human sepsis is a transient, self-limiting, and nonterminal response.

    PubMed

    Fonseca, Monique T; Rodrigues, Abner C; Cezar, Luana C; Fujita, Andre; Soriano, Francisco G; Steiner, Alexandre A

    2016-06-15

    Hypothermia in sepsis is generally perceived as something dysregulated and progressive although there has been no assessment on the natural course of this phenomenon in humans. This was the first study on the dynamics of hypothermia in septic patients not subjected to active rewarming, and the results were surprising. A sample of 50 subjects presenting with spontaneous hypothermia during sepsis was drawn from the 2005-2012 database of an academic hospital. Hypothermia was defined as body temperature below 36.0°C for longer than 2 h, with at least one reading of 35.5°C or less. The patients presented with 138 episodes of hypothermia, 21 at the time of the sepsis diagnosis and 117 with a later onset. However, hypothermia was uncommon in the final 12 h of life of the patients that succumbed. The majority (97.1%) of the hypothermic episodes were transient and self-limited; the median recovery time was 6 h; body temperature rarely fell below 34.0°C. Bidirectional oscillations in body temperature were evident in the course of hypothermia. Nearly half of the hypothermic episodes had onset in the absence of shock or respiratory distress, and the incidence of hypothermia was not increased during either of these conditions. Usage of antipyretic drugs, sedatives, neuroleptics, or other medications did not predict the onset of hypothermia. In conclusion, hypothermia appears to be a predominantly transient, self-limiting, and nonterminal phenomenon that is inherent to human sepsis. These characteristics resemble those of the regulated hypothermia shown to replace fever in animal models of severe systemic inflammation. PMID:26989218

  4. Local brain hypothermia for neuroprotection in stroke treatment and aneurysm repair.

    PubMed

    Wagner, Kenneth R; Zuccarello, Mario

    2005-04-01

    Hypothermia is well known to provide neuroprotection following various brain insults in experimental animals. Two recently completed clinical trials of whole body hypothermia in out-of-hospital cardiac arrest patients' demonstrated significantly improved survival rates and neurologic outcomes. These results provide new excitement and encouragement for clinical application of hypothermia in cerebrovascular disease. However, the intensive care challenges and adverse events (e.g. prolonged times to target temperatures, shivering and sedation, pneumonia) during the management of hypothermia, dampen enthusiasm for widespread application especially in elderly stroke patients. In this manuscript, we review recent hypothermia trials for stroke. We describe an alternate approach, i.e. local brain cooling, and discuss this new technique with reference to the extensive literature on the marked efficacy of hypothermia. We describe a new technology, the ChillerPad(TM) and ChillerStrip(TM) Systems developed by Seacoast Technologies, Inc. (Portsmouth, NH, USA). The latter device has received FDA approval and will be employed in a trial of local hypothermia for cerebral aneurysm repair. We present our experimental findings that profound local hypothermia does not damage cortical neurons. We also report that local hypothermia protects the blood-brain barrier and markedly reduces vasogenic edema development in an experimental intracerebral hemorrhage model. Lastly, we review potential mechanisms through which hypothermia provides blood-brain barrier protection and reduces edema formation. Clearly, hypothermia has a bright future for cerebrovascular disease treatment if brain cooling can be delivered in a manner that does not compromise the patient or the neurosurgical and intensive care settings. Local brain cooling may be just that new treatment approach.

  5. Pre-Hospital Trauma Care in Road Traffic Accidents in Kashan, Iran

    PubMed Central

    Paravar, Mohammad; Hosseinpour, Mehrdad; Salehi, Shayesteh; Mohammadzadeh, Mahdi; Shojaee, Abolfazl; Akbari, Hossein; Mirzadeh, Azadeh Sadat

    2013-01-01

    Background Iran has one of the highest rates of road traffic accidents (RTAs) worldwide. Pre-hospital trauma care can help minimize many instances of traffic-related mortality and morbidity. Objectives The aim of this study was to assess the characteristics of pre-hospital care in patients who were injured in RTAs, admitted to hospital. The focus was mainly directed at evaluating pre-hospital trauma care provided in city streets and roads out of the city. Patients and Methods This retrospective study was carried out on all trauma patients, transported by the emergency medical service (EMS) system, who were admitted to Kashan Shahid-Beheshti hospital during the period from March 2011 to March 2012. The patients’ demographic data, location of accident, damaged organs, mechanism of injury, injury severity, pre-hospital times (response, scene, transport), pre-hospital interventions and outcomes, were extracted from the data registry and analyzed through descriptive statistics using SPSS 18 software. Results Findings of this study showed that, 75% of RTAs occurred on city streets (n = 1 251). Motor-car accidents were the most frequent mechanism of RTA on city streets (n = 525) (42%), while car rollover was the most frequent mechanism of RTA on roads out of the city (n = 155) (44.4%). The mean pre-hospital time intervals (min); response, scene, and transport for all patients were 6.6 ± 3.1, 10.7 ± 5 and 13 ± 9.8, respectively. The mean pre-hospital time intervals (response, scene, transport) in roads out of the city were higher than those in city streets. There was a significant difference (P = 0.04) in the mortality rates due to RTAs between city streets (n = 46) and roads out of the city (n = 32). Conclusions In comparison with road traffic accidents on city streets, trauma patients in RTAs on roads out of the city have longer pre-hospital time intervals and more severe injuries; therefore, this group needs more pre-hospital resuscitation interventions. PMID

  6. Mapping the use of simulation in prehospital care – a literature review

    PubMed Central

    2014-01-01

    Background High energy trauma is rare and, as a result, training of prehospital care providers often takes place during the real situation, with the patient as the object for the learning process. Such training could instead be carried out in the context of simulation, out of danger for both patients and personnel. The aim of this study was to provide an overview of the development and foci of research on simulation in prehospital care practice. Methods An integrative literature review were used. Articles based on quantitative as well as qualitative research methods were included, resulting in a comprehensive overview of existing published research. For published articles to be included in the review, the focus of the article had to be prehospital care providers, in prehospital settings. Furthermore, included articles must target interventions that were carried out in a simulation context. Results The volume of published research is distributed between 1984- 2012 and across the regions North America, Europe, Oceania, Asia and Middle East. The simulation methods used were manikins, films, images or paper, live actors, animals and virtual reality. The staff categories focused upon were paramedics, emergency medical technicians (EMTs), medical doctors (MDs), nurse and fire fighters. The main topics of published research on simulation with prehospital care providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage. Conclusion Simulation were described as a positive training and education method for prehospital medical staff. It provides opportunities to train assessment, treatment and implementation of procedures and devices under realistic conditions. It is crucial that the staff are familiar with and trained on the identified topics, i.e., intubation, trauma care, CPR, ventilation and triage, which all, to a very large degree, constitute prehospital care. Simulation plays an integral role in this. The current state of

  7. The importance of cavity roosting and hypothermia to the energy balance of the winter acclimatized Carolina chickadee

    NASA Astrophysics Data System (ADS)

    Mayer, L.; Lustick, S.; Battersby, B.

    1982-09-01

    Noctural hypothermia and cavity roosting account for a significant reduction in energy expenditure in winter acclimatized Carolina chickadees. As much as 10‡C hypothermia amounted to a 33.0% reduction in metabolic requirements. Noctural hypothermia combined with a reduction in radiative and convective heat loss due to cavity roosting accounted for as much as a 50% savings in energy expenditure.

  8. Hypothermia-related deaths--United States, 1999-2002 and 2005.

    PubMed

    2006-03-17

    Hypothermia, defined as a core body temperature of <95 degrees F (<35 degrees C), is preventable. Excessive exposure to cold temperatures leads to potentially fatal central nervous system depression, arrhythmias, and renal failure. Advanced age, chronic medical conditions, substance abuse, and homelessness are among risk factors for hypothermia-related death. This report describes three hypothermia-related deaths that occurred during 2005 and reviews CDC data on hypothermia-related deaths during 1999-2002 in the United States. Public health strategies should target U.S. populations at increased risk for exposure to excessive cold and recommend behavior modification (e.g., dressing warmly, modifying activity levels, or avoiding alcohol) to help reduce mortality and morbidity from hypothermia. PMID:16543884

  9. Hypothermia-related deaths--United States, 1999-2002 and 2005.

    PubMed

    2006-03-17

    Hypothermia, defined as a core body temperature of <95 degrees F (<35 degrees C), is preventable. Excessive exposure to cold temperatures leads to potentially fatal central nervous system depression, arrhythmias, and renal failure. Advanced age, chronic medical conditions, substance abuse, and homelessness are among risk factors for hypothermia-related death. This report describes three hypothermia-related deaths that occurred during 2005 and reviews CDC data on hypothermia-related deaths during 1999-2002 in the United States. Public health strategies should target U.S. populations at increased risk for exposure to excessive cold and recommend behavior modification (e.g., dressing warmly, modifying activity levels, or avoiding alcohol) to help reduce mortality and morbidity from hypothermia.

  10. Platelet Function During Hypothermia in Experimental Mock Circulation.

    PubMed

    Van Poucke, Sven; Stevens, Kris; Kicken, Cécile; Simons, Antoine; Marcus, Abraham; Lancé, Marcus

    2016-03-01

    Alterations in platelet function are a common finding in surgical procedures involving cardiopulmonary bypass and hypothermia. Although the combined impact of hypothermia and artificial circulation on platelets has been studied before, the ultimate strategy to safely minimize the risk for bleeding and thrombosis is yet unknown. The aim of this study was to evaluate the use of a mock circulation loop to study the impact of hypothermia for platelet-related hemostatic changes. Venous blood was collected from healthy adult humans (n = 3). Closed mock circulation loops were assembled, each consisting of a centrifugal pump, an oxygenator with integrated heat exchanger, and a hardshell venous reservoir. The experiment started with the mock circulation temperature set at 37°C (T0 [0 h]). Cooling was then initiated at T1 (+2 h), where temperature was adjusted from 37°C to 32°C. Hypothermia was maintained from T2 (+4 h) to T3 (+28 h). From that point in time, rewarming from 32°C to 37°C was initiated with similar speed as cooling. From time point T4 (+30 h), normothermia (37°C) was maintained until the experiment ended at T5 (+32 h). Blood samples were analyzed in standard hematological tests: light transmission aggregometry (LTA) (arachidonic acid [AA], adenosine diphosphate [ADP], collagen [COL], thrombin-receptor-activating-peptide-14 [TRAP]), multiple electrode aggregometry (MEA) (AA, ADP, COL, TRAP), and rotational thromboelastometry (ROTEM) (EXTEM, FIBTEM, PLTEM). Hemoglobin, hematocrit, and platelet count decrease more substantially during temperature drop (37-32°C) than during hypothermia maintenance. Hb and Hct continue to follow this trend during active rewarming (32-37°C). PC increase from the moment active rewarming was initiated. None of the values return to the initial values. LTA values demonstrate a similar decrease in aggregation after stimulation with the platelet agonists between the start of the mock circulation and the start of cooling. Except

  11. End tidal carbon dioxide monitoring in prehospital and retrieval medicine: a review

    PubMed Central

    Donald, M J; Paterson, B

    2006-01-01

    End tidal carbon dioxide (ETCO2) monitoring is the non‐invasive measurement of exhaled CO2. The Intensive Care Society guidelines include (ETCO2) monitoring as one of the objective standards required for monitoring patients in transport, and the American Heart Association recommends that all intubations must be confirmed by some form of ETCO2 measurement. The physiological principles and technology underlying ETCO2 measurement and the clinical indication for its use in the prehospital environment are reviewed. ETCO2 monitoring has been widely established in the prehospital environment and is of particular use for verification of endotracheal tube placement. It is non‐invasive and easy to apply to breathing circuits. The units now available are compact and rugged, with extended battery operating times, which are ideally suited for prehospital use and should be considered as an essential item for advanced airway management. PMID:16921096

  12. The internationalisation of prehospital education: a merging of ideologies between Australia and the USA.

    PubMed

    Williams, B; Upchurch, J

    2006-07-01

    The aim of this project was to promote internationalisation of prehospital education collaboratively between students and teachers from EMS Education and Training, Montana, USA, and Monash University Centre for Ambulance and Paramedic Studies (MUCAPS), Victoria, Australia. The project required students and teachers to engage in a series of face to face lectures, which was reinforced through distance education strategies, such as online learning. The overall project aim was to establish an objective and descriptive view of the internationalisation of prehospital and community based emergency health education using e-learning as the educational approach. A cross sectional survey design using paper based evaluation was adopted in this project. Results revealed a positive student reaction, with flexible pedagogical processes broadening student learning and facilitating an international dimension otherwise not achievable. Given the current state of globalisation, internationalisation has the capacity to improve educational standards, quality, student interactions and specific learning outcomes in prehospital education.

  13. Myocardial protection by simple systemic hypothermia without aortic occlusion.

    PubMed

    Susilo, A W; Rocher, A; Mohan, R; van der Laarse, A

    1990-01-01

    Systemic hypothermia at 25 degrees-28 degrees C without chemical cardioplegia was used in 908 patients undergoing coronary artery bypass grafting. Local coronary artery flow was interrupted only during grafting of a distal anastomosis. Systemic perfusion pressure was maintained at 80-100 mmHg, hematocrit at 20%-25%, and pCO2 and pH were monitored during hypothermia according to the alpha-stat principle, while the left ventricle was vented routinely. Proximal anastomoses were performed just before extracorporeal circulation was started by only partially occluding the ascending aorta. Preoperatively 61.9% of the patients had had a myocardial infarction, and 44% had unstable angina. In 14% a severe lesion of the main stem of the left coronary artery was present. Left ventricular function was moderately depressed in 25% and severely depressed in 8% of the patients. Forty-eight patients (5.3%) were aged 70 years or older. The mean number of grafts placed per patient was 3.3. Perioperative myocardial infarction occurred in 3%. Death due to left ventricular failure occurred in 0.4%. No left ventricular assist devices were needed; an intra-aortic balloon pump was used in 1%; positive inotropic support was required in 3.8% of the patients. These results indicate that systemic hypothermia alone provides safe myocardial protection and in certain cases may be the method of choice, particularly if aortic cross clamping or administration of cardioplegic solution is contraindicated. In addition, this method provides rapid revascularization of a severely ischemic zone, as present after unsuccessful PTCA procedures.

  14. Multicenter trial of early hypothermia in severe brain injury.

    PubMed

    Clifton, Guy L; Drever, Pamala; Valadka, Alex; Zygun, David; Okonkwo, David

    2009-03-01

    The North American Brain Injury Study: Hypothermia IIR (NABIS:H IIR) is a randomized clinical trial designed to enroll 240 patients with severe brain injury between the ages of 16 and 45 years. The primary outcome measure is the dichotomized Glasgow Outcome Scale (GOS) at 6 months after injury. The study has the power to detect a 17.5% absolute difference in the percentage of patients with a good outcome with a power of 80%. All patients are randomized by waiver of consent unless family is immediately available. Enrollment is within 2.5 h of injury. Patients may be enrolled in the field by emergency medical services personnel affiliated with the study or by study personnel when the patient arrives at the emergency department. Patients who do not follow commands and have no exclusion criteria and who are enrolled in the hypothermia arm of the study are cooled to 35 degrees C as rapidly as possible by intravenous administration of up to 2 liters of chilled crystalloid. Those patients who meet the criteria for the second phase of the protocol (primarily a post-resuscitation GCS 3-8 without hypotension and without severe associated injuries) are cooled to 33 degrees C. Patients enrolled in the normothermia arm receive standard management at normothermia. As of December 2007, 74 patients had been randomized into phase II of the protocol. Patients in the hypothermia arm reached 35 degrees C in 2.7 +/- 1.1 (SD) h after injury and reached 33 degrees C at 4.4 +/- 1.5 h after injury.

  15. Retrospective study of the prevalence of postanaesthetic hypothermia in dogs.

    PubMed

    Redondo, J I; Suesta, P; Serra, I; Soler, C; Soler, G; Gil, L; Gómez-Villamandos, R J

    2012-10-13

    The anaesthetic records of 1525 dogs were examined to determine the prevalence of postanaesthetic hypothermia, its clinical predictors and consequences. Temperature was recorded throughout the anaesthesia. At the end of the procedure, details coded in were: hyperthermia (>39.50°C), normothermia (38.50°C-39.50°C), slight (38.49°C-36.50°C), moderate (36.49°C-34.00°C) and severe hypothermia (<34.00°C). Statistical analysis consisted of multiple regression to identify the factors that are associated with the temperature at the end of the procedure. Before premedication, the temperature was 38.7 ± 0.6°C (mean ± sd). At 60, 120 and 180 minutes from induction, the temperature was 36.7 ± 1.3°C, 36.1 ± 1.4°C and 35.8 ± 1.5°C, respectively. The prevalence of hypothermia was: slight, 51.5 per cent (95 per cent CI 49.0 to 54.0 per cent); moderate, 29.3 per cent (27.1-31.7 per cent) and severe: 2.8% (2.0-3.7%). The variables that associated with a decrease in the temperature recorded at the end of the anaesthesia were: duration of the preanesthetic time, duration of the anaesthesia, physical condition (ASA III and ASA IV dogs showed lower temperatures than ASA I dogs), the reason for anaesthesia (anaesthesia for diagnostic procedures or thoracic surgery reduce the temperature when compared with minor procedures), and the recumbency during the procedure (sternal and dorsal recumbencies showed lower temperatures than lateral recumbency). The temperature before premedication and the body surface (BS) were associated with a higher temperature at the end of the anaesthesia, and would be considered as protective factors.

  16. Effect of mild hypothermia on focal cerebral ischemia. Review of experimental studies.

    PubMed

    Miyazawa, Takahito; Tamura, Akira; Fukui, Shinji; Hossmann, Konstantin-Alexander

    2003-07-01

    The purposes of this review are to clarify the effect of hypothermia therapy on focal cerebral ischemia in rats, and to consider the relevancy of its application to human focal cerebral ischemia. Since 1990, 26 reports confirming the brain-protecting effect of hypothermia in rat focal cerebral ischemia models have been published. Seventy-four experimental groups in these 26 reports were classified as having transient middle cerebral arterial occlusion (MCAO) with mild hypothermia (group A; 43 groups), permanent MCAO with mild hypothermia (group B; 14 groups), permanent MCAO with deep hypothermia (group C; 8 groups) and transient or permanent MCAO with mild hyperthermia (group D; 9 groups). The results were evaluated as the % infarct volume change caused by hypothermia or hyperthermia compared with the infarct volume in normothermic animals. The effectiveness was confirmed in 36 (83%) of the 43 groups in group A, 10 (71%) of the 14 in group B, and six (75%) of the eight in group C. The infarct volume of eight of the nine groups in group D was markedly aggravated. The percent infarct volume change was 55.3% +/- 27.1% in group A, 57.6% +/- 24.7% in group B, 60.8% +/- 45.5% in group C, and 189.7% +/- 89.4% in group D. For effective reduction of the infarct volume, hypothermia should be started during ischemia or within 1 h, at latest, after the beginning of reperfusion in the rat transient MCAO model. However, it is not clear whether this neuroprotective effect of hypothermia can also be observed in the chronic stage, such as several months later. Keeping the body temperature normothermic in order to avoid mild hyperthermia seems to be rather important for not aggravating cerebral infarction. Clinical randomized studies on the efficacy of mild hypothermia for focal cerebral ischemia and sophisticated mild hypothermia therapy techniques are mandatory.

  17. [Studies on As2O3-induced rabbit hypothermia and brain monoamines (author's transl)].

    PubMed

    Kawaguchi, M

    1980-01-01

    It has been suggested that hypothermia induced in rabbits by As2O3 3 mg/kg (i.v.) depends mostly on the blocking of the thermo-regulatory center. The relationship between hypothermia induced by As2O3 and brain monoamine levels in rabbits was investigated. To clarify the mechanism of the hypothermia, the influence of pretreatment with several agents on As2O3-induced hypothermia and on monoamine levels in the hypothalamus was examined. The core temperature was measured by inserting the thermister probe into the rectum and noradrenaline(NA), 5-hydroxytryptamine(5-HT) and 5-hydroxyindoleacetic acid(5-HIAA) levels in the hypothalamus were estimated fluorometrically. Pretreatment with p-chlorophenylalanine(PCPA), alpha-methyl-p-tyrosine(alpha-MPT) or 5-hydroxytryptophan(5-HTP) did not inhibit the hypothermia induced by As2O3 but did decrease NA levels in the hypothalamus. On the contrary, pretreatment with barbital sodium, pheniprazine, 1-DOPA and 1-tyrosine significantly inhibited the hypothermia or exhibited the hyperthermia. As2O3-induced hypothermia in rabbits was followed by a decrease in NA levels and an increase in 5-HT levels in the hypothalamus. On the other hand, when the hypothermia induced by As2O3 was inhibited by pretreatment with barbital sodium, pheniprazine, 1-DOPA and 1-tyrosine, both NA and 5-HT levels in the hypothalamus were significantly increased. These results suggest that As2O3-induced hypothermia is due to a decrease in NA levels and inhibition of the hypothermia is due to an increase in NA levels, in the rabbit hypothalamus.

  18. Hypothermia and undressing associated with non-fatal bromazepam intoxication.

    PubMed

    Michaud, K; Romain, N; Giroud, C; Brandt, C; Mangin, P

    2001-12-27

    A 42-year-old woman with a history of depression was found unconscious, lying near her car in an early autumn morning. The lower part of her body was undressed and there were multiple purple spots and excoriations on the body suggesting at first a sexual assault. On admission to the intensive care unit, she presented a hypothermia with a central temperature of 28.4 degrees C. The biological samples obtained at the hospital were analysed. Blood concentration of bromazepam was 7.7 mg/l, which is above the highest level reported till now in a case of fatal intoxication. PMID:11792498

  19. Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias

    PubMed Central

    Perea-Milla, Emilio; Olalla, Julián; Sánchez-Cantalejo, Emilio; Martos, Francisco; Matute-Cruz, Petra; Carmona-López, Guadalupe; Fornieles, Yolanda; Cayuela, Aurelio; García-Alegría, Javier

    2009-01-01

    Background Mortality from invasive meningococcal disease (IMD) has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias. Methods A retrospective analysis was made of clinical reports of all patients (n = 848) diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables. Results Data were recorded on 848 patients, 49 (5.72%) of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93). Conclusion Pre-hospital oral antibiotherapy appears to reduce IMD mortality. PMID:19344518

  20. Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care

    PubMed Central

    2012-01-01

    Background Sepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis. Aim To describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis. Methods A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases. Results In overall terms, we found a small number of articles (n = 12 of 1,162 unique hits) which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis. Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS) for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT). Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT. There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers. Conclusion Severe sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis. PMID:22738027

  1. Designing a prehospital system for a developing country: estimated cost and benefits.

    PubMed

    Hauswald, M; Yeoh, E

    1997-10-01

    Many of the costs associated with prehospital care in developed countries are covered in budgets for fire suppression, police services, and the like. Determining these costs is therefore difficult. The costs and benefits of developing a prehospital care system for Kuala Lumpur, Malaysia, which now has essentially no emergency medical services (EMS) system, were estimated. Prehospital therapies that have been suggested to decrease mortality were identified. A minimal prehospital system was designed to deliver these treatments in Kuala Lumpur. The potential benefit of these therapies was calculated by using statistics from the United States corrected for demographic differences between the United States and Malaysia. Costs were extrapolated from the current operating budget of the Malaysian Red Crescent Society. Primary dysrhythmias are responsible for almost all potentially survivable cardiac arrests. A system designed to deliver a defibrillator to 85% of arrests within 6 minutes would require an estimated 48 ambulances. Kuala Lumpur has approximately 120 prehospital arrhythmic deaths per year. A 6% resuscitation rate was chosen for the denominator, resulting in seven survivors. Half of these would be expected to have significant neurological damage. Ambulances cost $53,000 (US dollars) to operate per year in Kuala Lumpur; 48 ambulances would cost a total of $2.5 million. Demographic factors and traffic problems would significantly increase the cost per patient. Other therapies, including medications, airway management, and trauma care, were discounted because both their additional cost and their benefit are small. Transport of patients (including trauma) is now performed by police or private vehicle and would probably take longer by ambulance. A prehospital system for Kuala Lumpur would cost approximately $2.5 million per year. It might save seven lives, three of which would be marred by significant neurological injury. Developing countries would do well to

  2. What is happening to the patient during pre-hospital trauma care?

    PubMed

    Hu, Peter; Defouw, Gregory; Mackenzie, Colin; Handley, Christopher; Seebode, Steven; Davies, Phil; Floccare, Douglas; Xiao, Yan

    2006-01-01

    We report a PDA based in-flight (pre-hospital) patient vital signs data recorder (VSDR) system which captures both numerical and continuous waveforms from a patient monitor in real-time. Nine pre-hospital Life-Saving-Intervention (LSI) event markers were configured for rapid real-time event documentation. A VSDR data set from first field encounter through hospital arrival could be wirelessly downloaded to a secure server and displayed on the VSDR-Viewer. Preliminary in-flight patient runs demonstrated the VSDR concept and future potential.

  3. Biothermal Model of Patient for Brain Hypothermia Treatment

    NASA Astrophysics Data System (ADS)

    Wakamatsu, Hidetoshi; Gaohua, Lu

    A biothermal model of patient is proposed and verified for the brain hypothermia treatment, since the conventionally applied biothermal models are inappropriate for their unprecedented application. The model is constructed on the basis of the clinical practice of the pertinent therapy and characterized by the mathematical relation with variable ambient temperatures, in consideration of the clinical treatments such as the vital cardiopulmonary regulation. It has geometrically clear representation of multi-segmental core-shell structure, database of physiological and physical parameters with a systemic state equation setting the initial temperature of each compartment. Its step response gives the time constant about 3 hours in agreement with clinical knowledge. As for the essential property of the model, the dynamic temperature of its face-core compartment is realized, which corresponds to the tympanic membrane temperature measured under the practical anesthesia. From the various simulations consistent with the phenomena of clinical practice, it is concluded that the proposed model is appropriate for the theoretical analysis and clinical application to the brain hypothermia treatment.

  4. Infrared fibers for radiometer thermometry in hypothermia and hyperthermia treatment

    SciTech Connect

    Katzir, A.; Bowman, H.F.; Asfour, Y.; Zur, A.; Valeri, C.R.

    1989-06-01

    Hypothermia is a condition which results from prolonged exposure to a cold environment. Rapid and efficient heating is needed to rewarm the patient from 32-35 degrees C to normal body temperature. Hyperthermia in cancer treatment involves heating malignant tumors to 42.5-43.0 degrees C for an extended period (e.g., 30 min) in an attempt to obtain remission. Microwave or radio frequency heating is often used for rewarming in hypothermia or for temperature elevation in hyperthermia treatment. One severe problem with such heating is the accurate measurement and control of temperature in the presence of a strong electromagnetic field. For this purpose, we have developed a fiberoptic radiometer system which is based on a nonmetallic, infrared fiber probe, which can operate either in contact or noncontact mode. In preliminary investigations, the radiometer worked well in a strong microwave or radiofrequency field, with an accuracy of +/- 0.5 degrees C. This fiberoptic thermometer was used to control the surface temperature of objects within +/- 2 degrees C.

  5. Acoustothermometric study of the human hand under hyperthrmia and hypothermia

    NASA Astrophysics Data System (ADS)

    Anosov, A. A.; Belyaev, R. V.; Vilkov, V. A.; Dvornikova, M. V.; Dvornikova, V. V.; Kazanskii, A. S.; Kuryatnikova, N. A.; Mansfel'd, A. D.

    2013-01-01

    The results of an acoustothermometric study of the human hand under local hyperthermia and hypothermia are presented. Individuals under testing plunged their hands in hot or cold water for several minutes. Thermal acoustic radiation was detected by two sensors placed near the palm and near the backside of the tested hand. The internal temperature profiles of the hand were reconstructed. The indirect estimate of the reconstruction error was 0.6°C, which is acceptable for medical applications. Hyperthermia was achieved by placing the hand in water with a maximal temperature of 44°C for 2 min. In this case, the internal temperature was 35.4 ± 0.6°C. Hypothermia was achieved by placing the hand in water with a temperature of 17.8°C for 15 min. In this case, the internal temperature decreased from 26 to 24°C. The use of a four-sensor planar receiving array allowed dynamic mapping of the acoustic brightness temperature of the hand.

  6. Hypothermia in mice tested in Morris water maze.

    PubMed

    Iivonen, Hennariikka; Nurminen, Liisa; Harri, Mikko; Tanila, Heikki; Puoliväli, Jukka

    2003-05-15

    The Morris water maze, one of the most common behavioral tasks to assess learning and memory in rodents, exposes the animals to cold water for a few minutes. Unlike rats, young healthy mice can become severely hypothermic during the task. Five swims of 45 s in 20 degrees C water with 30s between the trials was enough to cause up to 9 degrees C drop in the rectal temperature. The decline in core temperature was accompanied by slowing of the swimming speed. Moreover, the effect was dependent on the sex and genotype of the mice, such that females were more susceptible to hypothermia than males and transgenic mice carrying Alzheimer-associated APP and PS1 mutations more vulnerable than their nontransgenic littermates. Raising the water temperature from 20 to 24 degrees C alleviated the hypothermia, but did not remove the significant drop in core temperature when using 30-s inter-trial interval. However, increasing the break from 30 s to 13 min removed the net cooling effect of five trials on the core temperature and swimming speed. We conclude that the currently most common water maze protocol renders mice hypothermic, which may confound the test results, especially when transgenic female mice are used. We recommend monitoring of the swimming speed on a trial-by-trial basis and using longer inter-trial intervals.

  7. Ultrasonic vocalization by rat pups during recovery from deep hypothermia.

    PubMed

    Hofer, M A; Shair, H N

    1992-11-01

    Vocalization in the ultrasonic range (USV) has been reported to occur in young rodents in response to isolation, novelty, handling, and cold. Heretofore these calls have been known to occur only in alert, attentive, or emotionally aroused animals. These studies describe the emission of USV by comatose 9- to 10-day-old rat pups during recovery from deep hypothermia. Calling began at 15-18 degrees C core temperature while pups were virtually unresponsive to stimulation. Experimental results describe the patterns of call production in relation to respiration, cardiac function, colonic temperature, and brown adipose tissue thermogenesis. These vocalizations were 32-42 kHz in frequency, reached peak rates of 50/min at 23 degrees C, and were eliminated by laryngeal denervation, thus resembling isolation-induced vocalizations. However, contact with their dams failed to reduce call rates until pups had warmed above 25 degrees C. Newborn and weanling pups also emitted USV in deep hypothermia, but no USV were observed in pups recovering from general anesthesia. The possible functions and evolution of this behavior are discussed. PMID:1459345

  8. Prehospital Blood Product Resuscitation for Trauma: A Systematic Review

    PubMed Central

    Smith, Iain M.; James, Robert H.; Dretzke, Janine; Midwinter, Mark J.

    2016-01-01

    ABSTRACT Introduction: Administration of high ratios of plasma to packed red blood cells is a routine practice for in-hospital trauma resuscitation. Military and civilian emergency teams are increasingly carrying prehospital blood products (PHBP) for trauma resuscitation. This study systematically reviewed the clinical literature to determine the extent to which the available evidence supports this practice. Methods: Bibliographic databases and other sources were searched to July 2015 using keywords and index terms related to the intervention, setting, and condition. Standard systematic review methodology aimed at minimizing bias was used for study selection, data extraction, and quality assessment (protocol registration PROSPERO: CRD42014013794). Synthesis was mainly narrative with random effects model meta-analysis limited to mortality outcomes. Results: No prospective comparative or randomized studies were identified. Sixteen case series and 11 comparative studies were included in the review. Seven studies included mixed populations of trauma and non-trauma patients. Twenty-five of 27 studies provided only very low quality evidence. No association between PHBP and survival was found (OR for mortality: 1.29, 95% CI: 0.84–1.96, P = 0.24). A single study showed improved survival in the first 24 h. No consistent physiological or biochemical benefit was identified, nor was there evidence of reduced in-hospital transfusion requirements. Transfusion reactions were rare, suggesting the short-term safety of PHBP administration. Conclusions: While PHBP resuscitation appears logical, the clinical literature is limited, provides only poor quality evidence, and does not demonstrate improved outcomes. No conclusions as to efficacy can be drawn. The results of randomized controlled trials are awaited. PMID:26825635

  9. Determinants of Success and Failure in Prehospital Endotracheal Intubation

    PubMed Central

    Myers, Lucas A.; Gallet, Charles G.; Kolb, Logan J.; Lohse, Christine M.; Russi, Christopher S.

    2016-01-01

    Introduction This study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency. Methods We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth). We analyzed patient and EMS factors affecting ETI. Results During 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%). A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; p=0.03). A small tube (≤7.0 inches) was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (≥7.5 inches) (OR, 4.25; p=0.01). After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; p=0.001) and a nearly 40-fold (OR, 39.78; p<0.001) increased likelihood of successful intubation, respectively. Conclusion Successful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used. PMID:27625734

  10. Determinants of Success and Failure in Prehospital Endotracheal Intubation

    PubMed Central

    Myers, Lucas A.; Gallet, Charles G.; Kolb, Logan J.; Lohse, Christine M.; Russi, Christopher S.

    2016-01-01

    Introduction This study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency. Methods We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth). We analyzed patient and EMS factors affecting ETI. Results During 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%). A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; p=0.03). A small tube (≤7.0 inches) was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (≥7.5 inches) (OR, 4.25; p=0.01). After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; p=0.001) and a nearly 40-fold (OR, 39.78; p<0.001) increased likelihood of successful intubation, respectively. Conclusion Successful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used.

  11. Prehospital Identification of Stroke Subtypes in Chinese Rural Areas

    PubMed Central

    Jin, Hai-Qiang; Wang, Jin-Chao; Sun, Yong-An; Lyu, Pu; Cui, Wei; Liu, Yuan-Yuan; Zhen, Zhi-Gang; Huang, Yi-Ning

    2016-01-01

    Background: Differentiating intracerebral hemorrhage (ICH) from cerebral infarction as early as possible is vital for the timely initiation of different treatments. This study developed an applicable model for the ambulance system to differentiate stroke subtypes. Methods: From 26,163 patients initially screened over 4 years, this study comprised 1989 consecutive patients with potential first-ever acute stroke with sudden onset of the focal neurological deficit, conscious or not, and given ambulance transport for admission to two county hospitals in Yutian County of Hebei Province. All the patients underwent cranial computed tomography (CT) or magnetic resonance imaging to confirm the final diagnosis based on stroke criteria. Correlation with stroke subtype clinical features was calculated and Bayes’ discriminant model was applied to discriminate stroke subtypes. Results: Among the 1989 patients, 797, 689, 109, and 394 received diagnoses of cerebral infarction, ICH, subarachnoid hemorrhage, and other forms of nonstroke, respectively. A history of atrial fibrillation, vomiting, and diabetes mellitus were associated with cerebral infarction, while vomiting, systolic blood pressure ≥180 mmHg, and age <65 years were more typical of ICH. For noncomatose stroke patients, Bayes’ discriminant model for stroke subtype yielded a combination of multiple items that provided 72.3% agreement in the test model and 79.3% in the validation model; for comatose patients, corresponding agreement rates were 75.4% and 73.5%. Conclusions: The model herein presented, with multiple parameters, can predict stroke subtypes with acceptable sensitivity and specificity before CT scanning, either in alert or comatose patients. This may facilitate prehospital management for patients with stroke. PMID:27098788

  12. Neuroleptic-induced hypothermia in mice: lack of evidence for a central mechanism.

    PubMed Central

    Boschi, G.; Launay, N.; Rips, R.

    1987-01-01

    The present study investigated the ability of neuroleptic drugs to induce hypothermia in mice when they were administered intraperitoneally (i.p.) or intracerebroventricularly (i.c.v.). Twelve neuroleptics belonging to five chemical classes including phenothiazines, butyrophenones, benzamides, thioxanthenes and diphenylbutylpiperidines were injected i.p. All of them, except benzamides, induced a dose-dependent decrease in rectal temperature. Neuroleptics were administered i.c.v. via cannulae previously implanted in mice to determine whether this response might have a central origin. None of the drugs tested induced hypothermia at doses which did not produce toxic effects. These negative results suggest that neuroleptics act to elicit hypothermia via a peripheral, rather than a central mechanism. Since some neuroleptics possess alpha-adrenolytic properties which could induce hypothermia by promoting vasodilatation, we attempted to antagonize the hypothermia produced by peripheral administration of two neuroleptics with phenylephrine, an alpha-adrenoceptor agonist that does not cross the blood-brain barrier. The hypothermia induced by both chlorpromazine and haloperidol was attenuated by phenylephrine, supporting the view that peripheral alpha-adrenoceptors may mediate neuroleptic-induced hypothermia. PMID:2884008

  13. Detrimental effect of hypothermia during acute normovolaemic haemodilution in anaesthetized cats

    NASA Astrophysics Data System (ADS)

    Talwar, A.; Fahim, Mohammad

    Haemodynamic responses to hypothermia were studied at normal haematocrit and following the induction of acute normovolaemic haemodilution. Experiments were performed on 20 cats anaesthetized with a mixture of chloralose and urethane in two groups. In one group (n=10) the effects of hypothermia on various haemodynamic variables were studied at normal haematocrit (41.0+/-1.7%) and in the second group of cats (n=10) the effects of hypothermia on various haemodynamic variables were studied after the induction of acute normovolaemic haemodilution (14.0+/-1.0%). The haemodynamic variables left ventricular pressure, left ventricular contractility, arterial blood pressure, heart rate and right atrial pressure were recorded on a polygraph. Cardiac output was measured using a cardiac output computer. In both groups hypothermia was induced by surface cooling with the help of ice. Cardiovascular variables were recorded at each 1° C fall in body temperature. Hypothermia produced a significant (P<0.05) drop in heart rate, cardiac output, arterial blood pressure and left ventricular contractility in both groups. However, the percentage decrease in these variables in response to hypothermia was significantly (P<0.05) higher in cats with low haematocrit than in those with normal haematocrit. The severity of hypothermia - induced cardiovascular effects is evident from the drastic decrease in heart rate, cardiac output, arterial blood pressure and myocardial contractility in cats with low haematocrit, indicating a higher risk of circulatory failure under anaemic conditions at low temperatures.

  14. The effect of controlled mild hypothermia on large scald burns in a resuscitated rat model

    PubMed Central

    Tan, Nhi; Thode, Henry C; Singer, Adam J.

    2014-01-01

    Objective Early surface cooling of burns reduces pain, depth of injury and improves healing. We hypothesized that controlled mild hypothermia would also prolong survival in a fluid resuscitated rat model of large scald burns. Methods Forty rats were anesthetized and a single full-thickness scald burn covering 40% of total body surface area was created on each of the rats. The rats were then randomized to hypothermia (n=20) or no hypothermia (n=20). Mild hypothermia (a reduction of 2°C) was induced with intraperitoneal 4°C normal saline and ice packs. After 2 hours of hypothermia, the rats were rewarmed back to their baseline temperature with a heating pad. The control rats received room temperature intraperitoneal saline. The difference in survival between the groups was determined using Kaplan-Meier analysis and the log-rank test. Results Hypothermia was induced in all experimental rats within a mean of 22 minutes (95% confidence interval, 17 to 27). The number of normothermic and hypothermic rats that expired at each time interval were: at 1 hour, 4 vs. 0; at 10 hours, 2 from each group; at 24 hours, 0 vs. 1; at 48 hours, 2 vs. 2; at 72 hours, 1 vs. 1; and at 120 hours, 1 vs. 1 respectively. There were no differences in time to survival between the groups. Conclusion Induction of brief, mild hypothermia does not prolong survival in a resuscitated rat model of large scald burns.

  15. Establishing a hypothermia service for infants with suspected hypoxic-ischemic encephalopathy.

    PubMed

    Saliba, Elie; Fakhri, Nadine; Debillon, Thierry

    2015-04-01

    The translation of new treatments based upon established evidence into clinical practice is often difficult. The establishment of a therapeutic hypothermia (TH) service and a related cooling register would provide the opportunity to examine how a new therapy becomes implemented in a country or region. The objectives of a TH program should be: to provide guidance to clinicians who are considering the introduction of this new therapy; to ensure standardized clinical practices; to audit the implementation and conduct of TH; to provide surveillance for cooling-related adverse effects; and to evaluate the subsequent neurodevelopmental outcome. Prior to the use of TH, the most important practices to prioritize during its implementation should be identified and include the following: ensure timely identification of infants with neonatal encephalopathy; develop a coordinated system with the local or regional referral cooling center; develop a transport team capable of performing cooling during transport; ensure that each participating unit has access to a national encephalopathy register, and have developmental follow-up arrangements in place that are appropriate and uniform for the region/country.

  16. Establishing a hypothermia service for infants with suspected hypoxic-ischemic encephalopathy.

    PubMed

    Saliba, Elie; Fakhri, Nadine; Debillon, Thierry

    2015-04-01

    The translation of new treatments based upon established evidence into clinical practice is often difficult. The establishment of a therapeutic hypothermia (TH) service and a related cooling register would provide the opportunity to examine how a new therapy becomes implemented in a country or region. The objectives of a TH program should be: to provide guidance to clinicians who are considering the introduction of this new therapy; to ensure standardized clinical practices; to audit the implementation and conduct of TH; to provide surveillance for cooling-related adverse effects; and to evaluate the subsequent neurodevelopmental outcome. Prior to the use of TH, the most important practices to prioritize during its implementation should be identified and include the following: ensure timely identification of infants with neonatal encephalopathy; develop a coordinated system with the local or regional referral cooling center; develop a transport team capable of performing cooling during transport; ensure that each participating unit has access to a national encephalopathy register, and have developmental follow-up arrangements in place that are appropriate and uniform for the region/country. PMID:25683599

  17. Simplifying prehospital analgesia. Why certain medications should or should not be used for pain management in the field.

    PubMed

    Bledsoe, Bryan; Braude, Darren; Dailey, Michael W; Myers, Jeff; Richards, Mike; Wesley, Keith

    2005-07-01

    Prehospital analgesia can be safely provided with only three agents: fentanyl, morphine and the mixed-gas nitrous oxide/oxygen. Of these three, fentanyl is by far the best agent for general EMS analgesic therapy by paramedics. However, to initiate prehospital analgesia earlier in the EMS response time frame, EMT's should administer nitrous oxide/oxygen. This protocol can easily be added to the EMT education program or through a continuing education session. All of the other agents discussed have absolutely no role in modern prehospital care. PMID:16027666

  18. [Accidental hypothermia in the household environment. Importance of preclinical temperature measurement].

    PubMed

    Russo, S; Timmermann, A; Radke, O; Kerren, T; Bräuer, A

    2005-12-01

    In emergency medicine accidental hypothermia in non-traumatized patients is a rare situation. To emphasize the need for a precise preclinical temperature measurement, two cases of accidental hypothermia (28.2 degrees C and 29.3 degrees C core temperature) are presented which occurred under conditions that did not give a direct suspicion of hypothermia. In one case the immediate diagnosis lead to complete convalescence, the other patient died of multiple organ failure. The primary diagnosis, diagnostic methods and therapy as well as the primary treatment are discussed. PMID:16228151

  19. Outcomes of hypoxic-ischemic encephalopathy in neonates treated with hypothermia.

    PubMed

    Shankaran, Seetha

    2014-03-01

    This article examines the evidence regarding mortality and neurodevelopmental outcomes following hypothermia for neonatal hypoxic-ischemic encephalopathy. Data from randomized controlled trials regarding neurodevelopmental outcome at the end point of the major trials, and from 2 of the trials on childhood outcome following hypothermia for neonatal hypoxic-ischemic encephalopathy are presented. The predictors of outcome that can be evaluated in the neonatal period are also reviewed, as this information may assist in the counseling of families. Most trials of hypothermia have been performed in high-resource countries; published studies from the low- and middle-income countries are also reviewed.

  20. Effects of Crew Resource Management Training on Medical Errors in a Simulated Prehospital Setting

    ERIC Educational Resources Information Center

    Carhart, Elliot D.

    2012-01-01

    This applied dissertation investigated the effect of crew resource management (CRM) training on medical errors in a simulated prehospital setting. Specific areas addressed by this program included situational awareness, decision making, task management, teamwork, and communication. This study is believed to be the first investigation of CRM…

  1. Implementing an Innovative Prehospital Care Provider Training Course in Nine Cambodian Provinces

    PubMed Central

    Newberry, Jennifer A; Hattaway, Leonard (Bud) F; Socheat, Phan; Raingsey, Prak P; Strehlow, Matthew C

    2016-01-01

    Despite significant improvements in health outcomes nationally, many Cambodians continue to experience morbidity and mortality due to inadequate access to quality emergency medical services. Over recent decades, the Cambodian healthcare system and civil infrastructure have advanced markedly and now possess many of the components required to establish a well functioning emergency medical system. These components include enhanced access to emergency transportation through large scale road development efforts, widspread availability of emergency communication channels via the spread of cellphone and internet technology, and increased access to health services for poor patients through the implementation of health financing schemes. However, the system still lacks a number of key elements, one of which is trained prehospital care providers. Working in partnership with local providers, our team created an innovative, Cambodia-specific prehospital care provider training course to help fill this gap. Participants received training on prehospital care skills and knowledge most applicable to the Cambodian healthcare system, which was divided into four modules: Basic Prehospital Care Skills and Adult Medical Emergencies, Traumatic Emergencies, Obstetric Emergencies, and Neonatal/Pediatric Emergencies. The course was implemented in nine of Cambodia’s most populous provinces, concurrent with a number of overarching emergency medical service system improvement efforts. Overall, the course was administered to 1,083 Cambodian providers during a 27-month period, with 947 attending the entire course and passing the course completion exam.  PMID:27489749

  2. Prehospital coagulation monitoring of resuscitation with point-of-care devices.

    PubMed

    Schött, Ulf

    2014-05-01

    A variety of point-of-care monitors for the measurement of hematocrit, hemoglobin, blood gas with electrolytes, and lactate can be used also in the prehospital setting for optimizing and individualizing trauma resuscitation. Point-of-care coagulation testing with activated prothrombin test, prothrombin test, and activated coagulation/clotting time tests is available for prehospital use. Although robust, battery driven, and easy to handle, many devices lack documentation for use in prehospital care. Some of the devices correspond poorly to corresponding laboratory analyses in acute trauma coagulopathy and at lower hematocrits. In trauma, viscoelastic tests such as rotational thromboelastometry and thromboelastography can rapidly detect acute trauma coagulopathy and give an overall dynamic picture of the hemostatic system and the interaction between its different components: coagulation activation, fibrin polymerization, fibrin platelet interactions within the clot, and fibrinolysis. Rotational thromboelastometry is shock resistant and has the potential to be used outside the hospital setting to guide individualized coagulation factor and blood component therapies. Sonoclot and Rheorox are two small viscoelastic instruments with one-channel options, but with less documentation. The point-of-care market for coagulation tests is quickly expanding, and new devices are introduced all the time. Still they should be better adopted to prehospital conditions, small, robust, battery charged, and rapid and use small sample volumes and whole blood.

  3. The development and features of the Spanish prehospital advanced triage method (META) for mass casualty incidents.

    PubMed

    Arcos González, Pedro; Castro Delgado, Rafael; Cuartas Alvarez, Tatiana; Garijo Gonzalo, Gracia; Martinez Monzon, Carlos; Pelaez Corres, Nieves; Rodriguez Soler, Alberto; Turegano Fuentes, Fernando

    2016-01-01

    This text describes the process of development of the new Spanish Prehospital Advanced Triage Method (META) and explain its main features and contribution to prehospital triage systems in mass casualty incidents. The triage META is based in the Advanced Trauma Life Support (ATLS) protocols, patient's anatomical injuries and mechanism of injury. It is a triage method with four stages including early identification of patients with severe trauma that would benefit from a rapid evacuation to a surgical facility and introduces a new patient flow by-passing the advanced medical post to improve evacuation. The stages of triage META are: I) Stabilization triage that classifies patients according to severity to set priorities for initial emergency treatment; II) Identifying patients requiring urgent surgical treatment, this is done at the same time than stage I and creates a new flow of patients with high priority for evacuation; III) Implementation of Advanced Trauma Life Support protocols to patients previously classified according to stablished priority; and IV) Evacuation triage, stablishing evacuation priorities in case of lacks of appropriate transport resources. The triage META is to be applied only by prehospital providers with advanced knowledge and training in advanced trauma life support care and has been designed to be implemented as prehospital procedure in mass casualty incidents (MCI). PMID:27130042

  4. Trauma in elderly people: access to the health system through pre-hospital care1

    PubMed Central

    da Silva, Hilderjane Carla; Pessoa, Renata de Lima; de Menezes, Rejane Maria Paiva

    2016-01-01

    Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25%) and in the age range between 60 and 69 years (38.25%), average age 74.19 years (standard deviation±10.25). Among the mechanisms, falls (56.75%) and traffic accidents (31.25%) stood out, showing a significant relation with the pre-hospital care services (p<0.001). Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8%) were the most used, with trauma referral hospitals as the main destination (56.7%). Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims. PMID:27143543

  5. Prehospital Lactate Measurement by Emergency Medical Services in Patients Meeting Sepsis Criteria

    PubMed Central

    Boland, Lori L.; Hokanson, Jonathan S.; Fernstrom, Karl M.; Kinzy, Tyler G.; Lick, Charles J.; Satterlee, Paul A.; LaCroix, Brian K.

    2016-01-01

    Introduction We aimed to pilot test the delivery of sepsis education to emergency medical services (EMS) providers and the feasibility of equipping them with temporal artery thermometers (TATs) and handheld lactate meters to aid in the prehospital recognition of sepsis. Methods This study used a convenience sample of prehospital patients meeting established criteria for sepsis. Paramedics received education on systemic inflammatory response syndrome (SIRS) criteria, were trained in the use of TATs and hand-held lactate meters, and enrolled patients who had a recent history of infection, met ≥ 2 SIRS criteria, and were being transported to a participating hospital. Blood lactate was measured by paramedics in the prehospital setting and again in the emergency department (ED) via usual care. Paramedics entered data using an online database accessible at the point of care. Results Prehospital lactate values obtained by paramedics ranged from 0.8 to 9.8 mmol/L, and an elevated lactate (i.e. ≥ 4.0) was documented in 13 of 112 enrolled patients (12%). The unadjusted correlation of prehospital and ED lactate values was 0.57 (p< 0.001). The median interval between paramedic assessment of blood lactate and the electronic posting of the ED-measured lactate value in the hospital record was 111 minutes. Overall, 91 patients (81%) were hospitalized after ED evaluation, 27 (24%) were ultimately diagnosed with sepsis, and 3 (3%) died during hospitalization. Subjects with elevated prehospital lactate were somewhat more likely to have been admitted to the intensive care unit (23% vs 15%) and to have been diagnosed with sepsis (38% vs 22%) than those with normal lactate levels, but these differences were not statistically significant. Conclusion In this pilot, EMS use of a combination of objective SIRS criteria, subjective assessment of infection, and blood lactate measurements did not achieve a level of diagnostic accuracy for sepsis that would warrant hospital prenotification

  6. Use of prehospital ultrasound in North America: a survey of emergency medical services medical directors

    PubMed Central

    2014-01-01

    Background Advances in ultrasound imaging technology have made it more accessible to prehospital providers. Little is known about how ultrasound is being used in the prehospital environment and we suspect that it is not widely used in North America at this time. We believe that EMS system characteristics such as provider training, system size, population served, and type of transport will be associated with use or non-use of ultrasound. Our study objective was to describe the current use of prehospital ultrasound in North America. Methods This study was a cross-sectional survey distributed to EMS directors on the National Association of EMS Physicians (NAEMSP) mailing list. Respondents had the option to complete a paper or electronic survey. Results Of the 755 deliverable surveys we received 255 responses from across Canada and the United states for an overall response rate of 30%. Of respondents, 4.1% of EMS systems (95% CI 1.9, 6.3) reported currently using ultrasound and an additional 21.7% (95% CI 17, 26.4) are considering implementing ultrasound. EMS services using ultrasound have a higher proportion of physicians (p < 0.001) as their highest trained prehospital providers when compared to the survey group as a whole. The most commonly cited current and projected applications are Focused Abdominal Sonography for Trauma (FAST) and assessment of pulseless electrical activity (PEA) arrest. The cost of equipment and training are the most significant barriers to implementation of ultrasound. Most medical directors want evidence that prehospital ultrasound improves patient outcomes prior to implementation. Conclusions Prehospital ultrasound is infrequently used in North America and there are a number of barriers to its implementation, including costs of equipment and training and limited evidence demonstrating improved outcomes. A research agenda for prehospital ultrasound should focus on patient-important outcomes such as morbidity and mortality. Two commonly

  7. PHTLS ® (Prehospital Trauma Life Support) provider courses in Germany – who takes part and what do participants think about prehospital trauma care training?

    PubMed Central

    2014-01-01

    Background The goal of this study was to examine PHTLS Provider courses in Germany and to proof the assumption that formation of physicians and paramedics in prehospital trauma care can be optimized. Methods PHTLS participants were asked to fill out standardized questionnaires during their course preparation and directly after the course. There were some open questions regarding their professional background and closed questions concerning PHTLS itself. Further questions were to be answered on an analog scale in order to quantify subjective impressions of confidence, knowledge and also to describe individual levels of education and training. Results 247 questionnaires could be analyzed. Physicians noted significant (p < 0.001) more deficits in their professional training than paramedics. 80% of the paramedics affirmed to have had adequate training with respect to prehospital trauma care, all physicians claimed not to have had sufficient training for prehospital trauma care situations at Medical School. Physicians were statistically most significant dissatisfied then paramedics (p < 0.001). While most participants gave positive feedback, anesthetists were less convinced of PHTLS (p = 0.005), didn’t benefit as much as the rest (p = 0.004) and stated more often, that the course was of less value for their daily work (p = 0.03). After the course confidence increased remarkably and reached higher rates than before the course (p < 0.001). After PHTLS both groups showed similar ratings concerning the course concept indicating that PHTLS could equalize some training deficits and help to gain confidence and assurance in prehospital trauma situations. 90% of the paramedics and 100% of the physicians would recommend PHTLS. Physicians and especially anesthetists revised their opinions with regard to providing PHTLS at Medical School after having taken part in a PHTLS course. Conclusion The evaluation of PHTLS courses in Germany indicates the necessity for special prehospital

  8. Peripheral Adenosine A3 Receptor Activation Causes Regulated Hypothermia in Mice That Is Dependent on Central Histamine H1 Receptors

    PubMed Central

    Carlin, Jesse Lea; Tosh, Dilip K.; Xiao, Cuiying; Piñol, Ramón A.; Chen, Zhoumou; Salvemini, Daniela; Gavrilova, Oksana; Jacobson, Kenneth A.

    2016-01-01

    Adenosine can induce hypothermia, as previously demonstrated for adenosine A1 receptor (A1AR) agonists. Here we use the potent, specific A3AR agonists MRS5698, MRS5841, and MRS5980 to show that adenosine also induces hypothermia via the A3AR. The hypothermic effect of A3AR agonists is independent of A1AR activation, as the effect was fully intact in mice lacking A1AR but abolished in mice lacking A3AR. A3AR agonist–induced hypothermia was attenuated by mast cell granule depletion, demonstrating that the A3AR hypothermia is mediated, at least in part, via mast cells. Central agonist dosing had no clear hypothermic effect, whereas peripheral dosing of a non–brain-penetrant agonist caused hypothermia, suggesting that peripheral A3AR-expressing cells drive the hypothermia. Mast cells release histamine, and blocking central histamine H1 (but not H2 or H4) receptors prevented the hypothermia. The hypothermia was preceded by hypometabolism and mice with hypothermia preferred a cooler environmental temperature, demonstrating that the hypothermic state is a coordinated physiologic response with a reduced body temperature set point. Importantly, hypothermia is not required for the analgesic effects of A3AR agonists, which occur with lower agonist doses. These results support a mechanistic model for hypothermia in which A3AR agonists act on peripheral mast cells, causing histamine release, which stimulates central histamine H1 receptors to induce hypothermia. This mechanism suggests that A3AR agonists will probably not be useful for clinical induction of hypothermia. PMID:26606937

  9. Customer care. Patient satisfaction in the prehospital setting.

    PubMed

    Doering, G T

    1998-09-01

    The focus of the study was to prioritize six emergency medical service treatment factors in terms of their impact upon patient satisfaction in the prehospital setting. The six treatment areas analyzed were: EMS response time; medical care provided on scene; explanation of care by the provider; the provider's ability to reduce patient anxiety; the provider's ability to meet the patient's non-medical needs; and the level of courtesy/politeness shown by the EMS provider toward the patient. Telephone interviews were conducted with both patients and bystanders to obtain their perception of how well the system met their needs. The study analyzed how the six issues were rated and then evaluated the impact an individual's low score in a category had on that person's overall rating of the service provided. The overall satisfaction rating is not a calculated score, but an overall score specified by the respondent. The effect each issue had on the respondent's overall rating was determined by averaging the overall ratings for a category's low scorers, averaging the overall ratings for high scorers and then measuring the difference. Results of the study indicate that the factor with the greatest negative impact on patient satisfaction came from a perceived lack of crew courtesy and politeness. Respondents who indicated a fair to poor score in this category decreased their overall score by 60.2%. Ratings in other categories yielded the following results: When respondents rated the response time as fair to poor, their average overall rating showed an 18.4% decrease. When respondents rated the quality of medical care as fair to poor, their average overall rating showed a decrease of 22.6%. When the crew's ability to explain what was happening to the patient was rated as fair to poor, the average overall score dropped 33.6%. When the EMT's and medic's ability to reduce the patient's anxiety was rated fair to poor, average overall score declined by 32.6%. Finally, when the crew

  10. Intramuscular versus Intravenous Therapy for Prehospital Status Epilepticus

    PubMed Central

    Silbergleit, Robert; Durkalski, Valerie; Lowenstein, Daniel; Conwit, Robin; Pancioli, Arthur; Palesch, Yuko; Barsan, William

    2012-01-01

    . Adverse-event rates were similar in the two groups. CONCLUSIONS For subjects in status epilepticus, intramuscular midazolam is at least as safe and effective as intravenous lorazepam for prehospital seizure cessation. (Funded by the National Institute of Neurological Disorders and Stroke and others; ClinicalTrials.gov number, NCT00809146.) PMID:22335736

  11. Customer care. Patient satisfaction in the prehospital setting.

    PubMed

    Doering, G T

    1998-09-01

    The focus of the study was to prioritize six emergency medical service treatment factors in terms of their impact upon patient satisfaction in the prehospital setting. The six treatment areas analyzed were: EMS response time; medical care provided on scene; explanation of care by the provider; the provider's ability to reduce patient anxiety; the provider's ability to meet the patient's non-medical needs; and the level of courtesy/politeness shown by the EMS provider toward the patient. Telephone interviews were conducted with both patients and bystanders to obtain their perception of how well the system met their needs. The study analyzed how the six issues were rated and then evaluated the impact an individual's low score in a category had on that person's overall rating of the service provided. The overall satisfaction rating is not a calculated score, but an overall score specified by the respondent. The effect each issue had on the respondent's overall rating was determined by averaging the overall ratings for a category's low scorers, averaging the overall ratings for high scorers and then measuring the difference. Results of the study indicate that the factor with the greatest negative impact on patient satisfaction came from a perceived lack of crew courtesy and politeness. Respondents who indicated a fair to poor score in this category decreased their overall score by 60.2%. Ratings in other categories yielded the following results: When respondents rated the response time as fair to poor, their average overall rating showed an 18.4% decrease. When respondents rated the quality of medical care as fair to poor, their average overall rating showed a decrease of 22.6%. When the crew's ability to explain what was happening to the patient was rated as fair to poor, the average overall score dropped 33.6%. When the EMT's and medic's ability to reduce the patient's anxiety was rated fair to poor, average overall score declined by 32.6%. Finally, when the crew

  12. Hypothermia in VGKC antibody-associated limbic encephalitis.

    PubMed

    Jacob, S; Irani, S R; Rajabally, Y A; Grubneac, A; Walters, R J; Yazaki, M; Clover, L; Vincent, A

    2008-02-01

    Voltage-gated potassium channel antibody (VGKC-Ab)-associated limbic encephalitis (LE) is a recently described syndrome that broadens the spectrum of immunotherapy-responsive central nervous system disorders. Limbic encephalitis is typically characterised by a sub-acute onset of disorientation, amnesia and seizures, but the clinical spectrum is not yet fully defined and the syndrome could be under-diagnosed. We here describe the clinical profile of four patients with VGKC-Ab-associated LE who had intermittent, episodic hypothermia. One of the patients also described a prodrome of severe neuropathic pain preceding the development of limbic symptoms. Both of these novel symptoms responded well to immunosuppressive therapy, with concurrent amelioration of amnesia/seizures.

  13. Ethanol-induced hypothermia and hyperglycemia in genetically obese mice

    SciTech Connect

    Haller, E.W.; Wittmers, L.E. Jr.

    1989-01-01

    Blood glucose and rectal temperatures were monitored in two strains of genetically obese mice (C57 BL/6J ob/ob) prior to and following intragastric ethanol administration in an attempt to relate the hypothermic response to ethanol to extracellular glucose concentration. In contrast to expectation, ethanol administration was typically associated with a hyperglycemia and a hypothermic response. In the ob/ob genotype, the hypothermic response was associated with pronounced hyperglycemia which was more emphatic in older animals. The data support the conclusion that ethanol-induced hypothermia is independent of blood glucose levels. In light of the known sensitivity of ob/ob mice to insulin, it is suggested further that the observed hypothermic response was not a function of the animals' ability to transport glucose into peripheral cells. The observed hyperglycemia of the obese animals was most likely stress-related

  14. [Clinical characteristics of renal damage in patients with accidental hypothermia].

    PubMed

    Kuriyama, S; Tomonari, H; Numata, M; Imasawa, T; Hosoya, T

    1999-08-01

    We have investigated the clinical characteristics of renal damage and associated complications of 79 patients with accidental hypothermia whom we encountered over the last 5 years. All patients were male, with an average age of 58.9 +/- 9.2 years. Most of these patients were homeless. Body temperature on admission was 29.3 +/- 3.0 degrees C. The most common clinical manifestations on admission were consciousness disturbance and severe hypotension. Complications, including increase in serum transaminase, alcoholism, pneumonia, liver cirrhosis, sepsis, diabetes mellitus, hypoglycemia, acidosis, and an increased level of serum CPK and amylase were found frequently on admission. Death within 48 hours after admission occurred in 23 cases (the death rate; 23/79 = 29%). Renal damage was found in 36 cases (36/79 = 46%), consisting of acute renal failure (ARF) in 27, and acute on chronic in 6. Urinary diagnostic indices suggested that the etiological factor for ARF was pre-renal, which responded well to passive rewarming and an appropriate fluid replacement therapy, resulting in full recovery in most of the cases (the recovery rate; 25/27 = 93%). Among patients with renal damage, there were no cases requiring dialysis. The present data suggest that accidental hypothermia is a fatal condition with an extremely high death rate. It also is associated with multiple complications including ARF. The main cause for ARF is pre-renal, possibly caused by cold diuresis or dehydration superimposed on the underlying diseases such as alcoholism, diabetes mellitus, liver cirrhosis. Such complications, independent of renal damage, determine the patient's prognosis. PMID:10502943

  15. Insomnia Caused by Serotonin Depletion is Due to Hypothermia

    PubMed Central

    Murray, Nicholas M.; Buchanan, Gordon F.; Richerson, George B.

    2015-01-01

    Study Objective: Serotonin (5-hydroxytryptamine, 5-HT) neurons are now thought to promote wakefulness. Early experiments using the tryptophan hydroxylase inhibitor para-chlorophenylalanine (PCPA) had led to the opposite conclusion, that 5-HT causes sleep, but those studies were subsequently contradicted by electrophysiological and behavioral data. Here we tested the hypothesis that the difference in conclusions was due to failure of early PCPA experiments to control for the recently recognized role of 5-HT in thermoregulation. Design: Adult male C57BL/6N mice were treated with PCPA (800 mg/kg intraperitoneally for 5 d; n = 15) or saline (n = 15), and housed at 20°C (normal room temperature) or at 33°C (thermoneutral for mice) for 24 h. In a separate set of experiments, mice were exposed to 4°C for 4 h to characterize their ability to thermoregulate. Measurements and Results: PCPA treatment reduced brain 5-HT to less than 12% of that of controls. PCPA-treated mice housed at 20°C spent significantly more time awake than controls. However, core body temperature decreased from 36.5°C to 35.1°C. When housed at 33°C, body temperature remained normal, and total sleep duration, sleep architecture, and time in each vigilance state were the same as controls. When challenged with 4°C, PCPA-treated mice experienced a precipitous drop in body temperature, whereas control mice maintained a normal body temperature. Conclusions: These results indicate that early experiments using para-chlorophenylalanine that led to the conclusion that 5-hydroxytryptamine (5-HT) causes sleep were likely confounded by hypothermia. Temperature controls should be considered in experiments using 5-HT depletion. Citation: Murray NM, Buchanan GF, Richerson GB. Insomnia caused by serotonin depletion is due to hypothermia. SLEEP 2015;38(12):1985–1993. PMID:26194567

  16. THE MUSCARINIC ANTAGONIST SCOPOLAMINE ATTENUATES CHLORPYRIFOS INDUCED HYPOTHERMIA IN THE DEVELOPING RAT.

    EPA Science Inventory

    Chlorpyrifos (CHP), an anticholinesterase organophosphate (OP) pesticide, induces acute hypothermia in adult and developing rats. Previously we demonstrated that thermoregulation in preweanling pups is markedly more sensitive to the neurotoxic effects of CHP than in adults. The c...

  17. Heat and cold acclimation in helium-cold hypothermia in the hamster.

    NASA Technical Reports Server (NTRS)

    Musacchia, X. J.

    1972-01-01

    A study was made of the effects of acclimation of hamsters to high (34-35 C) and low (4-5 C) temperatures for periods up to 6 weeks on the induction of hypothermia in hamsters. Hypothermia was achieved by exposing hamsters to a helox mixture of 80% helium and 20% oxygen at 0 C. Hypothermic induction was most rapid (2-3 hr) in heat-acclimated hamsters and slowest (6-12 hr) in cold-acclimated hamsters. The induction period was intermediate (5-8 hr) in room temperature nonacclimated animals (controls). Survival time in hypothermia was relatable to previous temperature acclimations. The hypothesis that thermogenesis in cold-acclimated hamsters would accentuate resistance to induction of hypothermia was substantiated.

  18. [Effect of local hypothermia on H- and M-responses after spinal cord contusion in dogs].

    PubMed

    Iafarova, G G; Tumakaev, R F; Khazieva, A R; Baltina, T V

    2014-01-01

    In this study we investigated a motor-neuronal functional state based on H- and M-responses from m. quadratus plantae in dogs before and after experimental spinal cord contusion with and without following local intraoperative hypothermia. H- and M-responses from m. quadratus plantae were recorded during stimulation of the tibial nerve and results were compared between the groups. Our results demonstrate that local hypothermia applied after spinal cord contusion reduces amplitude of both M- and H-responses and also H(max)/M(max) ratio that may indicate depression of motorneurons excitability. After spinal cord contusion without following hypothermia the excitability of the spinal motorneurons during post-traumatic period, in opposite, was significantly increased. These results support a conclusion that intraoperative hypothermia after spinal cord contusion can delay development of functional excitability of the motoneurons and protect from further changes in H- and M-responses.

  19. Neonatal recurrent prolonged hypothermia associated with maternal mirtazapine treatment during pregnancy.

    PubMed

    Sokolover, Nir; Merlob, Paul; Klinger, Gil

    2008-01-01

    We present a case of recurrent hypothermia in concordant monozygotic twins born to a mirtazapine treated mother. The twins were born at 35 weeks gestation at birth weights of 2426 g and 2355 g. Both twins presented with recurrent hypothermia continuing until day 10 of life. Possible etiologies of hypothermia were excluded. The degree of prematurity and the weight of the twins were not consistent with prolonged thermal instability. The twins' mother was treated with mirtazapine during the entire pregnancy. Due to its serotonin and alpha 2 receptors antagonism mirtazapine is known to influence thermoregulation in adult humans and other mammals. We suggest that maternal mirtazapine treatment during pregnancy was associated with recurrent hypothermia in both identical twins.

  20. Collaboration between prehospital emergency medical teams and palliative care networks allows a better respect of a patient's will.

    PubMed

    Burnod, Alexis; Lenclud, Gaëlle; Ricard-Hibon, Agnès; Juvin, Philippe; Mantz, Jean; Duchateau, François-Xavier

    2012-02-01

    This study aimed to evaluate whether patient's wishes were respected by prehospital emergency medical teams after implementing collaboration and a standardized process between a community-based palliative network and the Emergency Medical Service system. Forty patients were included. In 75% of cases, the doctor of the prehospital emergency team decided in collaboration with the network's doctor according to the established procedure. This has enabled a respect of the care plan in 83% of cases. Without collaboration with the palliative care network, through the ignorance of its existence or through the wish of the prehospital emergency medical teams for taking decisions alone, the care plan was only respected in 40% of cases, P=0.025. Collaboration between prehospital emergency medical teams and community-based palliative care networks seems to enable a better respect of the care plan in the event of emergency situations affecting the patient in a palliative situation.

  1. Mild Hypothermia May Offer Some Improvement to Patients with MODS after CPB Surgery

    PubMed Central

    Zhao, Xiaoqi; Gu, Tianxiang; Xiu, Zongyi; Shi, Enyi; Yu, Lei

    2016-01-01

    OBJECTIVE: To summarize the effect of mild hypothermia on function of the organs in patients with multiple organ dysfunction syndrome after cardiopulmonary bypass surgery. METHODS: The patients were randomly divided into two groups, northermia group (n=71) and hypothermia group (n=89). We immediately began cooling the hypothermia group when test results showed multiple organ dysfunction syndrome, meanwhile all patients of two groups were drawn blood to test blood gas, liver and kidney function, blood coagulation function, and evaluated the cardiac function using echocardiography from 12 to 36 hours. We compared the difference of intra-aortic balloon pump, extracorporeal membrane oxygenation rate and mortality within one month after intensive care unit admission. RESULTS: Among the 160 patients, 36 died, 10 (11.24%) patients were from the hypothermia group and 26 (36.6%) from the northermia group (P <0.05). In northermia group, 45 (63.38%) patients used intra-aortic balloon pump and 4 (5.63%), extracorporeal membrane oxygenation; in hypothermia group, 35 (39.32%) patients used intra-aortic balloon pump and 2 (2.25%), extracorporeal membrane oxygenation( P <0.05). The patients' heart rate decreased significantly in the hypothermia group. The heart rate of hypothermia group is significantly slower than the northermia group at the 36th hour (P <0.05). But the mean arterial pressure of hypothermia group is significantly higher than the northermia group at the 36th hour (P <0.05). In hypothermia group, PO2, SvO2 and lactate were improved significantly compared to pre-cooling (P <0.05), and they were significantly better than the northermia group at the 36th hour (P <0.05%). Prothrombin time and activated partial thromboplastin time have no significantly difference between the two groups (P >0.05). But the platelet count has significantly difference between the two groups at the 36th hour (P <0.05). The aspartate transaminase, alanine transaminase and creatinine were

  2. [Assessment of therapeutic passive hypothermia in newborns with hypoxic-ischemic encephalopathy that need interhospital transport].

    PubMed

    Fuentes-Ruiz, José A; Lagares-Franco, Carolina; Rodríguez-Molina, Óscar; Cordero-Cañas, Enrique; Benavente-Fernández, Isabel

    2015-04-01

    Introduccion. La hipotermia inducida durante las primeras horas de vida del recien nacido es un tratamiento eficaz para reducir la mortalidad y secuelas graves en neonatos que han sufrido un episodio de hipoxia perinatal. Este procedimiento requiere una asistencia universalizada independiente del centro donde haya nacido, siendo necesario su traslado al hospital de referencia. Objetivo. Evaluar la eficacia del traslado interhospitalario del neonato con encefalopatia hipoxico-isquemica en hipotermia pasiva. Pacientes y metodos. Estudio descriptivo de series de casos con caracter retrospectivo. Se estudiaron neonatos de la provincia de Cadiz que precisaron hipotermia inducida. Se incluyo a un total de 46 neonatos en el analisis: 33 de ellos (71,74%) precisaron traslado por el Servicio de Traslados de Pacientes Criticos (grupo TPC); el resto (28,26%) nacio en el centro de referencia. Resultados. Ambos grupos son comparables en edad gestacional al nacimiento, sexo, peso y grado de encefalopatia hipoxico-isquemica. Se analizan variables relacionadas con la aplicacion de la hipotermia, y en el grupo TPC se analizan variables relacionadas con el traslado. No se aprecian diferencias significativas entre los grupos en la efectividad-consecuencia de la terapia neuroprotectora con hipotermia al alta hospitalaria (p = 0,159). No se encuentran complicaciones derivadas del traslado interhospitalario. Conclusiones. El traslado interhospitalario del neonato en hipotermia terapeutica realizado de forma pasiva es efectivo, seguro y necesario para el cumplimiento de la terapia. Es preciso consensuar la asistencia con el servicio de referencia, estableciendo guias en cuanto al soporte y rango de temperatura adecuada, consolidando asi una asistencia integral.

  3. Predicting outcome after cardiopulmonary arrest in therapeutic hypothermia patients: clinical, electrophysiological and imaging prognosticators.

    PubMed

    Maia, Bruno; Roque, Rafael; Amaral-Silva, Alexandre; Lourenço, Sónia; Bento, Luís; Alcântara, João

    2013-01-01

    Introdução: A determinação do prognóstico em sobreviventes comatosos de paragem cárdio-respiratória baseia-se em evidência adquirida sobretudo antes do advento da hipotermia terapêutica. O nosso objectivo é avaliar a capacidade preditiva de dados clínicos, electrofisiológicos e imagiológicos após a hipotermia terapêutica. Materiais e Métodos: Análise retrospectiva e consecutiva de doentes que foram tratados com hipotermia durante os anos de 2010 e 2011. Foram obtidos dados relativamente ao exame neurológico, potenciais evocados somatossensitivos e auditivos, electroencefalograma e ressonância magnética crânio-encefálica, nas primeiras 72 horas após o evento. O outcome definido foi a escala Glasgow Outcome Scale dicotomizada em mau prognóstico (pontuações 1 e 2) e bom prognóstico (pontuações 3, 4 e 5). Resultados: Estudados no total 26 doentes. Reflexos pupilares, corneanos e oculocefálicos abolidos, ausência de respostas N20 nos potenciais evocados somatossensitivos, estado de mal mioclónico e um padrão ‘maligno’ na electroencefalografia relacionaram-se com mau prognóstico, sem falsos-positivos (p = 0,05). Dois doentes classificados com bom outcome demonstraram respostas motoras ausentes ou em extensão nas primeiras 72 horas, originando uma taxa de falsos-positivos de 25% para este parâmetro (p = 0,008). Ambos requereram sedação até às 72 horas. A presença de isquémia na ressonância não teve relação significativa com o outcome. Discussão: A abolição dos reflexos pupilares, corneanos e oculocefálicos, a ausência de respostas N20 nos potenciais evocados, estado de mal mioclónico e um padrão electroencefalográfico ‘maligno’ mantêm-se parâmetros de mau prognóstico válidos em doentes submetidos a hipotermia terapêutica. Conclusão: A necessidade de sedação nestes doentes pode diminuir a capacidade prognóstica das respostas motoras.

  4. [The methodology of therapeutic hypothermia in children born in a state of asphyxia].

    PubMed

    Antonov, A G; Ionov, O V; Kirtbaia, A R; Balashova, E N; Nikitina, I V; Ryndin, A Iu; Miroshnik, E V; Degtiarev, D N

    2014-01-01

    This guideline provides the diagnostic and treatment algorithm for newborns with gestational age over 35 weeks and weighing more than 1800g who has severe asphyxia in birth with the threat of severe or medium-severe hypoxic-ischemic encephalopathy. PMID:25831709

  5. Cold Hearts: a case study of therapeutic hypothermia in helicopter emergency medical services (HEMS).

    PubMed

    Tilney, Peter; Kendall, Kevin

    2009-01-01

    A 36-year-old white man hit a home run in the seventh inning of a community baseball game. The patient ran the bases successfully and returned to home plate. As he was bending over to pick up the bat, he suddenly collapsed. Bystander cardiopulmonary resuscitation (CPR) was immediately initiated, and defibrillation occurred within 5 minutes per the local emergency medical services (EMS) service. The automated external defibrillator (AED) shocked the patient a total of three times, and he was transported to a local hospital at the basic life support level. Helicopter emergency service (HEMS) was activated by local medical control, and LifeFlight of Maine responded to transfer this patient to a tertiary care center.

  6. Torpor and hypothermia: reversed hysteresis of metabolic rate and body temperature.

    PubMed

    Geiser, Fritz; Currie, Shannon E; O'Shea, Kelly A; Hiebert, Sara M

    2014-12-01

    Regulated torpor and unregulated hypothermia are both characterized by substantially reduced body temperature (Tb) and metabolic rate (MR), but they differ physiologically. Although the remarkable, medically interesting adaptations accompanying torpor (e.g., tolerance for cold and ischemia, absence of reperfusion injury, and disuse atrophy) often do not apply to hypothermia in homeothermic species such as humans, the terms "torpor" and "hypothermia" are often used interchangeably in the literature. To determine how these states differ functionally and to provide a reliable diagnostic tool for differentiating between these two physiologically distinct states, we examined the interrelations between Tb and MR in a mammal (Sminthopsis macroura) undergoing a bout of torpor with those of the hypothermic response of a similar-sized juvenile rat (Rattus norvegicus). Our data show that under similar thermal conditions, 1) cooling rates differ substantially (approximately fivefold) between the two states; 2) minimum MR is approximately sevenfold higher during hypothermia than during torpor despite a similar Tb; 3) rapid, endogenously fuelled rewarming occurs in torpor but not hypothermia; and 4) the hysteresis between Tb and MR during warming and cooling proceeds in opposite directions in torpor and hypothermia. We thus demonstrate clear diagnostic physiological differences between these two states that can be used experimentally to confirm whether torpor or hypothermia has occurred. Furthermore, the data can clarify the results of studies investigating the ability of physiological or pharmacological agents to induce torpor. Consequently, we recommend using the terms "torpor" and "hypothermia" in ways that are consistent with the underlying regulatory differences between these two physiological states.

  7. Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study.

    PubMed Central

    Gentilello, L M; Jurkovich, G J; Stark, M S; Hassantash, S A; O'Keefe, G E

    1997-01-01

    OBJECTIVE: The purpose of this randomized, prospective clinical trial was to determine whether hypothermia during resuscitation is protective or harmful to critically injured trauma patients. SUMMARY BACKGROUND DATA: Hypothermia has both protective and harmful clinical effects. Retrospective studies show higher mortality in patients with hypothermia; however, hypothermia is more common in more severely injured patients, which makes it difficult to determine whether hypothermia contributes to mortality independently of injury severity. There are no randomized, prospective treatment studies to assess hypothermia's impact as an independent variable. METHODS: Fifty-seven hypothermic (T < or = 34.5 C), critically injured patients requiring a pulmonary artery catheter were randomized to a rapid rewarming protocol using continuous arteriovenous rewarming (CAVR) or to a standard rewarming (SR) control group. The primary outcome of interest was first 24-hour blood product and fluid resuscitation requirements. Other comparative analyses included coagulation assays, hemodynamic and oxygen transport measurements, length of stay, and mortality. RESULTS: The two groups were well matched for demographic and injury severity characteristics. CAVR rewarmed significantly faster than did SR (p < 0.01), producing two groups with different amounts of hypothermia exposure. The patients who underwent CAVR required less fluid during resuscitation to the same hemodynamic goals (24,702 mL vs. 32,540 mL, p = 0.05) and were significantly more likely to rewarm (p = 0.002). Only 2 (7%) of 29 patients who underwent CAVR failed to warm to 36 C and both died, whereas 12 (43%) of 28 patients who underwent SR failed to reach 36 C, and all 12 died. Patients who underwent CAVR had significantly less early mortality (p = 0.047). CONCLUSION: Hypothermia increases fluid requirements and independently increases acute mortality after major trauma. PMID:9351712

  8. Moderate Hypothermia Significantly Decreases Hippocampal Cell Death Involving Autophagy Pathway after Moderate Traumatic Brain Injury

    PubMed Central

    Jin, Yichao; Lin, Yingying; Feng, Jun-feng; Jia, Feng; Gao, Guo-yi

    2015-01-01

    Abstract Here, we evaluated changes in autophagy after post-traumatic brain injury (TBI) followed by moderate hypothermia in rats. Adult male Sprague-Dawley rats were randomly divided into four groups: sham injury with normothermia group (37°C); sham injury with hypothermia group (32°C); TBI with normothermia group (TNG; 37°C); and TBI with hypothermia group (THG; 32°C). Injury was induced by a fluid percussion TBI device. Moderate hypothermia (32°C) was achieved by partial immersion in a water bath (0°C) under general anesthesia for 4 h. All rats were killed at 24 h after fluid percussion TBI. The ipsilateral hippocampus in all rats was analyzed with hematoxylin and eosin staining; terminal deoxynucleoitidyl transferase-mediated nick end labeling staining was used to determine cell death in ipsilateral hippocampus. Immunohistochemistry and western blotting of microtubule-associated protein light chain 3 (LC3), Beclin-1, as well as transmission electron microscopy performed to assess changes in autophagy. At 24 h after TBI, the cell death index was 27.90±2.36% in TNG and 14.90±1.52% in THG. Expression level of LC3 and Beclin-1 were significantly increased after TBI and were further up-regulated after post-TBI hypothermia. Further, ultrastructural observations showed that there was a marked increase of autophagosomes and autolysosomes in ipsilateral hippocampus after post-TBI hypothermia. Our data demonstrated that moderate hypothermia significantly attenuated cell death and increased autophagy in ipsilateral hippocampus after fluid percussion TBI. In conclusion, autophagy pathway may participate in the neuroprotective effect of post-TBI hypothermia. PMID:25942484

  9. ATP induces mild hypothermia in rats but has a strikingly detrimental impact on focal cerebral ischemia

    PubMed Central

    Zhang, Meijuan; Li, Wenjin; Niu, Guangming; Leak, Rehana K; Chen, Jun; Zhang, Feng

    2013-01-01

    Ischemic stroke is a devastating condition lacking effective therapies. A promising approach to attenuate ischemic injury is mild hypothermia. Recent studies show that adenosine nucleotides can induce hypothermia in mice. The purpose of the present study was to test the hypothesis that adenosine 5′-triphosphate (ATP) induces mild hypothermia in rats and reduces ischemic brain injury. We found that intraperitoneal injections of ATP decreased core body temperature in a dose-dependent manner; the dose appropriate for mild hypothermia was 2 g/kg. When ATP-induced hypothermia was applied to stroke induced by middle cerebral artery occlusion, however, a neuroprotective effect was not observed. Instead, the infarct volume grew even larger in ATP-treated rats. This was accompanied by an increased rate of seizure events, hemorrhagic transformation, and higher mortality. Continuous monitoring of physiologic parameters revealed that ATP reduced heartbeat rate and blood pressure. ATP also increased blood glucose, accompanied by severe acidosis and hypocalcemia. Western blotting showed that ATP decreased levels of both phospho-Akt and total-Akt in the cortex. Our results reveal that, despite inducing hypothermia, ATP is not appropriate for protecting the brain against stroke. Instead, we show for the first time that ATP treatment is associated with exaggerated ischemic outcomes and dangerous systemic side effects. PMID:23072747

  10. [Hypothermia induced alteration of refractoriness in the ventricular myocardium of ground souirrel Citellus undulatus].

    PubMed

    Kuz'min, V S; Abramov, A A; Egorov, Iu V; Rozenshtraukh, L V

    2014-12-01

    Bioelectrical activity and refractoriness in ventricular myocardium of the hibernator--ground squirrel Citellus undulatus were investigated during hypothermia. Experiments were performed with use of isolated, perfused preparations of papillary muscle from right ventricular. Preparations were obtained from hibernating (HS), summer active (SAS) squirrels and from rats. Bioelectrical activity was registered using the standard microelectrode technique at 37-17 degrees C. Action potentials duration (APD), refractoriness duration (RD) and the velocity of the action potential wave front (dV/dt) were estimated. Hypothermia induced APD and RD prolongation were demonstrated in all groups of experimental animals. However, normalized RD was significantly longer in the HS group during hypothermia than in SAS and rats. Ratio of RD to APD in HS group exceeds unity at 17 degrees C, which allows to suggest so called "postrepolarization refractoriness" during hypothermia. Also, HS reveal more prominent preservation of dV/dt during hypothermia than SAS and rat. Significant prolongation of RD and maintenance of normal excitation conduction during hypothermia probably plays essential role in hibernators resistivity to cold induced arrhythmias.

  11. Influence of hypothermia on the pharmacokinetics of gentamicin and theophylline in piglets.

    PubMed

    Koren, G; Barker, C; Bohn, D; Kent, G; Biggar, W D

    1985-10-01

    The influence of hypothermia on gentamicin and theophylline pharmacokinetics was studied in anesthetized pigs given an iv bolus of gentamicin and theophylline during normothermia (37 degrees C) and again 1 wk later after the induction of controlled hypothermia (29 degrees C). During hypothermia, the elimination half-time for gentamicin was significantly prolonged (135 +/- 19 min at 37 degrees C vs. 187 +/- 7 min at 29 degrees C), and there were significant decreases in the volume of the central compartment (Vc) of gentamicin, the gentamicin volume of distribution (Vd), and the gentamicin total body clearance (TBC). Hypothermia was associated with a small but significant decrease in theophylline Vd and Vc, but no change in TBC. In separate experiments, cardiac output decreased during the induction of hypothermia in a temperature-dependent fashion. The changes in gentamicin Vd and TBC may be explained by the decrease in cardiac output and the associated decrease in glomerular filtration rate. This study suggests that the elimination of theophylline, which has a relatively low hepatic extraction ratio, is not influenced by the hypothermia-induced decrease in liver blood flow.

  12. Prehospital trauma care reduces mortality. Ten-year results from a time-cohort and trauma audit study in Iraq

    PubMed Central

    2012-01-01

    Background Blunt implementation of Western trauma system models is not feasible in low-resource communities with long prehospital transit times. The aims of the study were to evaluate to which extent a low-cost prehospital trauma system reduces trauma deaths where prehospital transit times are long, and to identify specific life support interventions that contributed to survival. Methods In the study period from 1997 to 2006, 2,788 patients injured by land mines, war, and traffic accidents were managed by a chain-of-survival trauma system where non-graduate paramedics were the key care providers. The study was conducted with a time-period cohort design. Results 37% of the study patients had serious injuries with Injury Severity Score ≥ 9. The mean prehospital transport time was 2.5 hours (95% CI 1.9 - 3.2). During the ten-year study period trauma mortality was reduced from 17% (95% CI 15 -19) to 4% (95% CI 3.5 - 5), survival especially improving in major trauma victims. In most patients with airway problems, in chest injured, and in patients with external hemorrhage, simple life support measures were sufficient to improve physiological severity indicators. Conclusion In case of long prehospital transit times simple life support measures by paramedics and lay first responders reduce trauma mortality in major injuries. Delegating life-saving skills to paramedics and lay people is a key factor for efficient prehospital trauma systems in low-resource communities. PMID:22304808

  13. Paramedics' and pre-hospital physicians' assessments of anatomic injury in trauma patients: a cohort study

    PubMed Central

    2010-01-01

    Background The pre-hospital assessment of a blunt trauma is difficult. Common triage tools are the mechanism of injury (MOI), vital signs, and anatomic injury (AI). Compared to the other tools, the clinical assessment of anatomic injury is more subjective than the others, and, hence, more dependent on the skills of the personnel. The aim of the study was to estimate whether the training and qualifications of the personnel are associated with the accuracy of prediction of anatomic injury and the completion of pre-hospital procedures indicated by local guidelines. Methods Adult trauma patients met by a trauma team at Helsinki University Trauma Centre during a 12-month period (n = 422) were retrospectively analysed. To evaluate the accuracy of prediction of anatomic injury, clinically assessed pre-hospital injuries in six body regions were compared to injuries assessed at hospital in two patient groups, the patients treated by pre-hospital physicians (group 1, n = 230) and those treated by paramedics (group 2, n = 190). Results The groups were comparable in respect to age, sex, and MOI, but the patients treated by physicians were more severely injured than those treated by paramedics [ISS median (interquartile range) 16 (6-26) vs. 6 (2-10)], thus rendering direct comparison of the groups ineligible. The positive predictive values (95% confidence interval) of assessed injury were highest in head injury [0,91 (0,84-0,95) in group 1 and 0,86 (0,77-0,92) in group 2]. The negative predictive values were highest in abdominal injury [0,85 (0,79-0,89) in group 1 and 0,90 (0,84-0,93) in group 2]. The measurements of agreement between injuries assessed pre- and in-hospitally were moderate in thoracic and extremity injuries. Substantial kappa values (95% confidence interval) were achieved in head injury, 0,67 (0,57-0,77) in group 1 and 0,63 (0,52-0,74) in group 2. The rate of performing the pre-hospital procedures as indicated by the local instructions was 95-99%, except for

  14. ThermoSpots to Detect Hypothermia in Children with Severe Acute Malnutrition

    PubMed Central

    Mole, Thomas B.; Kennedy, Neil; Ndoya, Noel; Emond, Alan

    2012-01-01

    Introduction Hypothermia is a risk factor for increased mortality in children with severe acute malnutrition (SAM). Yet frequent temperature measurement remains unfeasible in under-resourced units in developing countries. ThermoSpot is a continuous temperature monitoring sticker designed originally for neonates. When applied to skin, its liquid crystals are designed to turn black with hypothermia and remain green with normothermia. Aims To (i) estimate the diagnostic accuracy of ThermoSpots for detecting WHO-defined hypothermia (core temperature <35.5°C or peripheral temperature <35.0°C) in children with SAM and (ii) determine their acceptability amongst mothers. Methods Children with SAM in a malnutrition unit in Malawi were enrolled during March-July 2010. The sensitivity and specificity of ThermoSpots were calculated by comparing the device colour against ‘gold standard’ rectal temperatures taken on admission and follow up peripheral temperatures taken until discharge. Guardians completed a questionnaire to assess acceptability. Results Hypothermia was uncommon amongst the 162 children enrolled. ThermoSpot successfully detected the one rectal temperature and two peripheral temperatures recorded that met the WHO definition of hypothermia. Overall, 3/846 (0.35%) temperature measurements were in the WHO-defined hypothermia range. Interpreting the brown transition colour (between black and green) as hypothermia improved sensitivities. For milder hypothermia definitions, sensitivities declined (<35.4°C, 50.0%; <35.9°C, 39.2%). Specificity was consistently above 94%. From questionnaires, 40/43 (93%) mothers reported they were 90–100% happy with the device overall. Free-text answers revealed themes of “Skin Rashes”, “User-satisfaction” and “Empowerment". Conclusion Although hypothermia was uncommon in this study, ThermoSpots successfully detected these episodes in malnourished children and were acceptable to mothers. Research in settings where

  15. Adrenocortical response in rats subjected to a stress of restraint by immobilization whether accompanied by hypothermia or not

    NASA Technical Reports Server (NTRS)

    Buchel, L.; Prioux-Guyonneau, M.; Libian, L.

    1980-01-01

    The restraint associated with hypothermia which increases the adrenal activity in rats was investigated. In rats with nomothermia or light hypothermia, the plasma and adrenal corticosterone levels increase at least threefold whatever the duration of restraint. Their return to normal values depends on the duration of the restraint. Exposure to cold produces in free rats a light hypothermia with an increase of the plasma and adrenal corticosterone levels, and in restraint animals an important hypothermia which does not potentiate the stimulation of adrenocortical activity induced by the restraint alone.

  16. Blood oxygenation during hyperpressure intraperitoneal fluid administration in a rabbit model of severe liver injury: Evaluation of a novel concept for control of pre-hospital liver bleeding

    PubMed Central

    Ahmadi-Noorbakhsh, Siavash; Azizi, Saeed; Dalir-Naghadeh, Bahram; Maham, Masoud

    2012-01-01

    Oxygen is an essential part of the most important metabolic pathways in aerobic organisms. Oxygen delivery is merely dependent on blood, rendering blood loss a devastating event. Traumatic pre-hospital liver bleeding is a major cause of early trauma deaths in human and animals, with no established therapeutic method yet. Increasing intra-abdominal pressure (IAP) has been shown to reduce liver bleeding by half. Although reduction of blood loss could be in favor of blood oxygen delivery, however, the complex interaction between increased IAP and respiratory mechanics during severe hemorrhagic shock remained unclear. We used a novel model of liver trauma in 16 rabbits and randomly assigned them to either normotensive abdomen group or increased IAP by fluid infusion (HA) groups (n=8 each). Liver size and the amount of liver injury were evaluated. Various blood oxygenation parameters were recorded. Both groups were identical in terms of the liver size and injury. The HA group had significantly lower shock index. Arterial oxygen capacity and oxygen content were higher in the HA group. No significant statistical difference was seen between groups in terms of abdominal perfusion pressure; alveolar pressure of oxygen; dissolved oxygen in blood plasma; alveolar to arterial oxygen tension gradient; arterial to alveolar oxygen pressure ratio; the ratio between partial pressure of arterial oxygen and fraction of inspired oxygen; and respiratory index. In conclusion, the novel therapeutic method of increasing IAP by fluid infusion in a rabbit model of liver hemorrhage preserved blood oxygenation better than the classic therapeutic method. PMID:25653758

  17. [Pre-hospital care for wounded in military conflicts: state and prospects].

    PubMed

    Samokhvalov, I M; Reva, V A

    2015-10-01

    Pre-hospital care is one of the most important links in a chain of the military medical tenet. A survival of the most of severe casualties at the scene depends on a good quality and well-timed first aid and paramedic care. Based on the current state of medical equipment and training of the soldiers of the Russian and foreign armies, we summarized the data about the main medical products designed for pre-hospital care, briefly analyzed and compared their effectiveness to the foreign analogues. It is currently obvious, that fundamental changes in First aid kit modification and Medical Bags are warranted according to the reality and soldier's demands in combat operations. Proposals for modernization of military medical equipment were put forward. PMID:26827503

  18. Better Glasgow outcome score, cerebral perfusion pressure and focal brain oxygenation in severely traumatized brain following direct regional brain hypothermia therapy: A prospective randomized study

    PubMed Central

    Idris, Zamzuri; Zenian, Mohd Sofan; Muzaimi, Mustapha; Hamid, Wan Zuraida Wan Abdul

    2014-01-01

    Background: Induced hypothermia for treatment of traumatic brain injury is controversial. Since many pathways involved in the pathophysiology of secondary brain injury are temperature dependent, regional brain hypothermia is thought capable to mitigate those processes. The objectives of this study are to assess the therapeutic effects and complications of regional brain cooling in severe head injury with Glasgow coma scale (GCS) 6-7. Materials and Methods: A prospective randomized controlled pilot study involving patients with severe traumatic brain injury with GCS 6 and 7 who required decompressive craniectomy. Patients were randomized into two groups: Cooling and no cooling. For the cooling group, analysis was made by dividing the group into mild and deep cooling. Brain was cooled by irrigating the brain continuously with cold Hartmann solution for 24-48 h. Main outcome assessments were a dichotomized Glasgow outcome score (GOS) at 6 months posttrauma. Results: A total of 32 patients were recruited. The cooling-treated patients did better than no cooling. There were 63.2% of patients in cooling group attained good GOS at 6 months compared to only 15.4% in noncooling group (P = 0.007). Interestingly, the analysis at 6 months post-trauma disclosed mild-cooling-treated patients did better than no cooling (70% vs. 15.4% attained good GOS, P = 0.013) and apparently, the deep-cooling-treated patients failed to be better than either no cooling (P = 0.074) or mild cooling group (P = 0.650). Conclusion: Data from this pilot study imply direct regional brain hypothermia appears safe, feasible and maybe beneficial in treating severely head-injured patients. PMID:25685201

  19. Hypothermia as a predictor for mortality in trauma patients at admittance to the Intensive Care Unit

    PubMed Central

    Balvers, Kirsten; Van der Horst, Marjolein; Graumans, Maarten; Boer, Christa; Binnekade, Jan M.; Goslings, J. Carel; Juffermans, Nicole P.

    2016-01-01

    Aims: To study the impact of hypothermia upon admission to the Intensive Care Unit (ICU) on early and late mortality and to develop a prediction model for late mortality in severely injured trauma patients. Materials and Methods: A multicenter retrospective cohort study was performed in adult trauma patients admitted to the ICU of two Level-1 trauma centers between 2007 and 2012. Hypothermia was defined as a core body temperature of ≤35° Celsius. Logistic regression analyses were performed to quantify the effect of hypothermia on 24-hour and 28-day mortality and to develop a prediction model. Results: A total of 953 patients were included, of which 354 patients had hypothermia (37%) upon ICU admission. Patients were divided into a normothermic or hypothermic group. Hypothermia was associated with a significantly increased mortality at 24 hours and 28 days (OR 2.72 (1.18-6.29 and OR 2.82 (1.83-4.35) resp.). The variables included in the final prediction model were hypothermia, age, APACHE II score (corrected for temperature), INR, platelet count, traumatic brain injury and Injury Severity Score. The final prediction model discriminated between survivors and non-survivors with high accuracy (AUC = 0.871, 95% CI 0.844-0.898). Conclusions: Hypothermia, defined as a temperature ≤35° Celsius, is common in critically ill trauma patients and is one of the most important physiological predictors for early and late mortality in trauma patients. Trauma patients admitted to the ICU may be at high risk for late mortality if the patient is hypothermic, coagulopathic, severely injured and has traumatic brain injury or an advanced age. PMID:27512330

  20. Prehospital transport practices prevalent among patients presenting to the pediatric emergency of a tertiary care hospital

    PubMed Central

    Sankar, Jhuma; Singh, Archana; Narsaria, Praveen; Dev, Nishanth; Singh, Pradeep; Dubey, Nandkishore

    2015-01-01

    Background and Objectives: Prehospital transport practices prevalent among children presenting to the emergency are under-reported. Our objectives were to evaluate the prehospital transport practices prevalent among children presenting to the pediatric emergency and their subsequent clinical course and outcome. Methods: In this prospective observational study we enrolled all children ≤17 years of age presenting to the pediatric emergency (from January to June 2013) and recorded their demographic data and variables pertaining to prehospital transport practices. Data was entered into Microsoft Excel and analyzed using Stata 11 (StataCorp, College Station, TX, USA). Results: A total of 319 patients presented to the emergency during the study period. Acute gastroenteritis, respiratory tract infection and fever were the most common reasons for presentation to the emergency. Seventy-three (23%) children required admission. Most commonly used public transport was auto-rickshaw (138, 43.5%) and median time taken to reach hospital was 22 min (interquartile range: 5, 720). Twenty-six patients were referred from another health facility. Of these, 25 were transported in ambulance unaccompanied. About 8% (25) of parents reported having difficulties in transporting their child to the hospital and 57% (181) of parents felt fellow passengers and drivers were unhelpful. On post-hoc analysis, only time taken to reach the hospital (30 vs. 20 min; relative risk [95% confidence interval]: 1.02 [1.007, 1.03], P = 0.003) and the illness nature were significant (45% vs. 2.6%; 0.58 [0.50, 0.67], P ≤ 0.0001) on multivariate analysis. Conclusions: In relation to prehospital transport among pediatric patients we observed that one-quarter of children presenting to the emergency required admission, the auto-rickshaw was the commonest mode of transport and that there is a lack of prior communication before referring patients for further management. PMID:26321808

  1. Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review.

    PubMed

    Ebben, Remco H A; Vloet, Lilian C M; Verhofstad, Michael H J; Meijer, Sanne; Mintjes-de Groot, Joke A J; van Achterberg, Theo

    2013-01-01

    A gap between guidelines or protocols and clinical practice often exists, which may result in patients not receiving appropriate care. Therefore, the objectives of this systematic review were (1) to give an overview of professionals' adherence to (inter)national guidelines and protocols in the emergency medical dispatch, prehospital and emergency department (ED) settings, and (2) to explore which factors influencing adherence were described in studies reporting on adherence. PubMed (including MEDLINE), CINAHL, EMBASE and the Cochrane database for systematic reviews were systematically searched. Reference lists of included studies were also searched for eligible studies. Identified articles were screened on title, abstract and year of publication (≥1990) and were included when reporting on adherence in the eligible settings. Following the initial selection, articles were screened full text and included if they concerned adherence to a (inter)national guideline or protocol, and if the time interval between data collection and publication date was <10 years. Finally, articles were assessed on reporting quality. Each step was undertaken by two independent researchers. Thirty-five articles met the criteria, none of these addressed the emergency medical dispatch setting or protocols. Median adherence ranged from 7.8-95% in the prehospital setting, and from 0-98% in the ED setting. In the prehospital setting, recommendations on monitoring came with higher median adherence percentages than treatment recommendations. For both settings, cardiology treatment recommendations came with relatively low median adherence percentages. Eight studies identified patient and organisational factors influencing adherence. The results showed that professionals' adherence to (inter)national prehospital and emergency department guidelines shows a wide variation, while adherence in the emergency medical dispatch setting is not reported. As insight in influencing factors for adherence in the

  2. Effect of educational television commercial on pre-hospital delay in patients with ischemic stroke.

    PubMed

    Nishijima, Haruo; Kon, Tomoya; Ueno, Tatsuya; Haga, Rie; Yamazaki, Keishi; Yagihashi, Kei; Funamizu, Yukihisa; Arai, Akira; Suzuki, Chieko; Nunomura, Jin-ichi; Baba, Masayuki; Tomiyama, Masahiko

    2016-01-01

    Administering intravenous recombinant tissue plasminogen activator (r-tPA) within 4.5 h or endovascular procedures within 8 h of ischemic stroke onset may reduce the risk of disability. The effectiveness of media campaigns to raise stroke awareness and shorten pre-hospital delay is unclear. We studied 1144 consecutive ischemic stroke patients at Aomori Prefectural Central Hospital, Japan, between March 2010 and February 2014. From March 2012, the government sponsored an educational campaign based on a television commercial to improve knowledge of stroke symptoms and encourage ambulance calls for facial palsy, arm palsy, or speech disturbance. For the 544 and 600 patients admitted before and during the intervention, respectively, we recorded the National Institutes of Health Stroke Scale score, stroke type, the time when patients or bystanders recognized stroke symptoms, and hospital arrival time. Pre-hospital delay, as the time interval from awareness of stroke to hospital arrival, was categorized as 0-3, 3-6, and 6+ h. The mean pre-hospital delay was shorter (12.0 vs 13.5 h; P = 0.0067), the proportion of patients arriving within 3 h was larger (55.7 vs 46.5 %; P = 0.0021), and the proportion arriving after 6 h was smaller (32.7 vs 39.5 %; P = 0.0162) in the intervention group than in the pre-intervention group. There was no significant difference in the proportion of patients treated with r-tPA (6 and 7.5 % of the intervention and pre-intervention groups, respectively). A television-based public education campaign potentially reduced pre-hospital delay for ischemic stroke patients, but the r-tPA treatment rate was unchanged.

  3. Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients

    PubMed Central

    Scheppke, Kenneth A.; Braghiroli, Joao; Shalaby, Mostafa; Chait, Robert

    2014-01-01

    Introduction Violent and agitated patients pose a serious challenge for emergency medical services (EMS) personnel. Rapid control of these patients is paramount to successful prehospital evaluation and also for the safety of both the patient and crew. Sedation is often required for these patients, but the ideal choice of medication is not clear. The objective is to demonstrate that ketamine, given as a single intramuscular injection for violent and agitated patients, including those with suspected excited delirium syndrome (ExDS), is both safe and effective during the prehospital phase of care, and allows for the rapid sedation and control of this difficult patient population. Methods We reviewed paramedic run sheets from five different catchment areas in suburban Florida communities. We identified 52 patients as having been given intramuscular ketamine 4mg/kg IM, following a specific protocol devised by the EMS medical director of these jurisdictions, to treat agitated and violent patients, including a subset of which would be expected to suffer from ExDS. Twenty-six of 52 patients were also given parenteral midazolam after medical control was obtained to prevent emergence reactions associated with ketamine. Results Review of records demonstrated that almost all patients (50/52) were rapidly sedated and in all but three patients no negative side effects were noted during the prehospital care. All patients were subsequently transported to the hospital before ketamine effects wore off. Conclusion Ketamine may be safely and effectively used by trained paramedics following a specific protocol. The drug provides excellent efficacy and few clinically significant side effects in the prehospital phase of care, making it an attractive choice in those situations requiring rapid and safe sedation especially without intravenous access. PMID:25493111

  4. Liquid ventilator for ultrafast hypothermia induction in juvenile lambs: Preliminary results.

    PubMed

    Nadeau, Mathieu; Sage, Michaël; Kohlhauer, Matthias; Robert, Raymond; Vandamne, Jonathan; Mousseau, Julien; Tissier, Renaud; Praud, Jean-Paul; Walti, Hervé; Micheau, Philippe

    2015-08-01

    Total liquid ventilation (TLV) is an emerging mechanical ventilation technique. In this technique, the lungs are filled with liquid perfluorocarbons (PFC) and a liquid ventilator assures ventilation by periodically renewing a volume of oxygenated, CO2 freed and temperature controlled PFC. A huge difference between conventional mechanical ventilation and TLV relates to the fact that PFCs are about 1500 times denser than air. Thus, the PFCs filled lungs turn into an efficient heat exchanger with the circulating blood. One of the most appealing utilization of the lungs as a heat exchanger in TLV is for ultrafast induction of mild therapeutic hypothermia (MTH) for neuroprotection and cardioprotection after ischemia-reperfusion injuries. This study aimed to perform ultrafast MTH induction by TLV in animals up to 25 kg, then perform a fast post-hypothermic rewarming while maintaining proper ventilation. A thermal model of the lamb and liquid ventilator was developed to predict the dynamic and the control strategy to adopt for MTH induction. Two juvenile lambs were instrumented with temperature sensors in the femoral artery, pulmonary artery, oesophagus, right eardrum and rectum. After stabilization in conventional mechanical ventilation, TLV was initiated with ultrafast MTH induction, followed by posthypothermic rewarming. Preliminary results in the two juvenile lambs reveal that the liquid ventilator Inolivent-6.0 can induce MTH by TLV in less than 2.5 min for systemic arterial blood and in less than 10 min for venous return, esophagus and eardrum. Rectal temperature reached MTH in respectively 19.4 and 17.0 min for both lambs. Experimental results were consistent with the model predictions. Moreover, blood gas analysis exhibited that the gas exchange in the lungs was maintained adequately for the entire experiments.

  5. Back strength and flexibility of EMS providers in practicing prehospital providers.

    PubMed

    Crill, Matthew T; Hostler, David

    2005-06-01

    In the execution of prehospital care duties, an EMS provider may be required to carry equipment and patients over long distances or over multiple flights of stairs at any time of the day. At a minimum, a prehospital provider must have sufficient lower back strength and hamstring flexibility to prevent musculoskeletal injury while lifting. This study administered fitness assessments related to the occupational activities of the prehospital provider with the purpose of describing the incidence of occupational back injury and percentage of providers with known risk factors for back injury. Ninety subjects were tested during a regional EMS conference. Men were significantly taller and heavier than women and had significantly less hamstring flexibility. Body Mass Index was 30.7 +/- 7.2 in men and 28 +/- 5.7 in women. However, no significant differences were noted in an extension test of back strength. When surveyed, 47.8% of subjects reported a back injury in the previous 6 months but only 39.1% of these injuries were sustained while performing EMS duties. While only 13% of these injuries resulted in missed work, 52.2% reported their injury interfered with their daily activities. In spite of the physical nature of the profession, EMS providers in our sample were significantly overweight according to their Body Mass Index and may lack sufficient back strength and flexibilityfor safe execution of their duties. This group of professionals may be at risk for occupational injury and should be targeted for interventions to improve strength and flexibility.

  6. Impact of Prehospital Care on Outcomes in Sepsis: A Systematic Review

    PubMed Central

    Smyth, Michael A; Brace-McDonnell, Samantha J; Perkins, Gavin D

    2016-01-01

    Introduction Sepsis is a common and potentially life-threatening response to an infection. International treatment guidelines for sepsis advocate that treatment be initiated at the earliest possible opportunity. It is not yet clear if very early intervention by ambulance clinicians prior to arrival at hospital leads to improved clinical outcomes among sepsis patients. Methoda We systematically searched the electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed up to June 2015. In addition, subject experts were contacted. We adopted the GRADE (grading recommendations assessment, development and evaluation) methodology to conduct the review and follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations to report findings. Results Nine studies met the eligibility criteria – one study was a randomized controlled trial while the remaining studies were observational in nature. There was considerable variation in the methodological approaches adopted and outcome measures reported across the studies. Because of these differences, the studies did not answer a unique research question and meta-analysis was not appropriate. A narrative approach to data synthesis was adopted. Conclusion There is little robust evidence addressing the impact of prehospital interventions on outcomes in sepsis. That which is available is of low quality and indicates that prehospital interventions have limited impact on outcomes in sepsis beyond improving process outcomes and expediting the patient’s passage through the emergency care pathway. Evidence indicating that prehospital antibiotic therapy and fluid resuscitation improve patient outcomes is currently lacking. PMID:27429693

  7. Cardiac hypertrophy in chick embryos induced by hypothermia

    SciTech Connect

    Boehm, C.; Johnson, T.R.; Caston, J.D.; Przybylski, R.J.

    1987-01-01

    A decrease in incubation temperature from 38 to 32/sup 0/C elicits a decrease in chicken embryo size and weight with concomitant heart enlargement if done after day 10 of incubation. When assayed at day 18 of incubation with the hypothermia started on day 11 or 14, evidence is presented that the heart enlargement is an hypertrophy with no detectable hyperplasia. Supporting data are presented for various physical parameters showing increases in heart wet and dry weight, volume, area, wall thickness, and cell size. There was little difference in DNA content and nuclear (/sup 3/H)thymidine labeling index between hearts of control and hypothermic embryos. Hearts of hypothermic embryos showed a slight increase in water content and considerable increases in RNA, protein, and glycogen content per unit DNA. The average size of polysomes isolated from hypothermic hearts was larger than that of polysomes isolated from controls. Microscopic studies showed no obvious increase in amount of capillary beds, connective tissue, and myocardial cells. Annulate lamellae were found only in myocardial cells of hypothermic embryos in sparse amounts and low frequency but always associated with large deposits of glycogen.

  8. Hypothermia modulates circadian clock gene expression in lizard peripheral tissues.

    PubMed

    Vallone, Daniela; Frigato, Elena; Vernesi, Cristiano; Foà, Augusto; Foulkes, Nicholas S; Bertolucci, Cristiano

    2007-01-01

    The molecular mechanisms whereby the circadian clock responds to temperature changes are poorly understood. The ruin lizard Podarcis sicula has historically proven to be a valuable vertebrate model for exploring the influence of temperature on circadian physiology. It is an ectotherm that naturally experiences an impressive range of temperatures during the course of the year. However, no tools have been available to dissect the molecular basis of the clock in this organism. Here, we report the cloning of three lizard clock gene homologs (Period2, Cryptochrome1, and Clock) that have a close phylogenetic relationship with avian clock genes. These genes are expressed in many tissues and show a rhythmic expression profile at 29 degrees C in light-dark and constant darkness lighting conditions, with phases comparable to their mammalian and avian counterparts. Interestingly, we show that at low temperatures (6 degrees C), cycling clock gene expression is attenuated in peripheral clocks with a characteristic increase in basal expression levels. We speculate that this represents a conserved vertebrate clock gene response to low temperatures. Furthermore, these results bring new insight into the issue of whether circadian clock function is compatible with hypothermia.

  9. Neuropeptide Y induces torpor-like hypothermia in Siberian hamsters.

    PubMed

    Paul, Matthew J; Freeman, David A; Park, Jin Ho; Dark, John

    2005-09-01

    Intracerebroventricular (ICV) injections of neuropeptide Y (NPY) are known to decrease body temperature (Tb) of laboratory rats by 1-3 degrees C. Several NPY pathways in the brain terminate in hypothalamic structures involved in energy balance and thermoregulation. Laboratory rats are homeothermic, maintaining Tb within a narrow range. We examined the effect of ICV injected NPY on Tb in the heterothermic Siberian hamster (Phodopus sungorus), a species that naturally undergoes daily torpor in which Tb decreases by as much as 15-20 degrees C. Minimum effective dose was determined in preliminary testing then various doses of NPY were tested in cold-acclimated Siberian hamsters while food was withheld. NPY markedly reduced Tb in the heterothermic Siberian hamster. In addition, the reduction in Tb in 63% of the observations was sufficient to reach the criterion for daily torpor (Tb < 32 degrees C for at least 30 min). Neither the incidence of torpor nor its depth or duration was related to NPY dose. Both likelihood and magnitude of response varied within animals on different test days. NPY decreased 24-h food intake and this was exaggerated in the animals reaching criterion for torpor; the decrease in food intake was positively correlated with the magnitude of the decrease in Tb. The mild hypothermia seen in homeothermic laboratory rats after NPY injected ICV is exaggerated, often greatly, in the heterothermic Siberian hamster. NPY treatment may be activating hypothalamic systems that normally integrate endogenous torpor-producing signals and initiate torpor.

  10. Effect of task complexity on mental performance during immersion hypothermia.

    PubMed

    Giesbrecht, G G; Arnett, J L; Vela, E; Bristow, G K

    1993-03-01

    The effect of task complexity on the decrement in mental performance during immersion hypothermia was studied. Psychometric tests of varying length and complexity were administered: 1) prior to cold water immersion (baseline); 2) soon after immersion to the neck in cold (8 degrees C) water but prior to any decrease in core temperature; and 3) after 55 to 80 min of immersion when core temperature had decreased 2-4 degrees C. Results indicated that tests placing relatively minimal cognitive demands on individuals, such as auditory attention, the Benton visual recognition test and forward digit span, were unaffected by either initial cold water immersion or central cooling. On the other hand, tests requiring relatively greater mental manipulation and short term memory (i.e., backward digit span) or processing and analysis (i.e., Stroop test) showed a slight improvement upon cold water immersion (perhaps related to increased arousal and/or learning) but a significant decrement following central cooling of 2-4 degrees C. Thus, relatively simple tasks were unaffected by central cooling, whereas more complex tasks were adversely affected. Cold water immersion itself did not interfere with performance of any tasks. Central nervous system cooling probably interferes with mental processing although discomfort and/or the physiological and physical effects of cold on the neuromuscular aspects of speech, required for responses to some of the tasks, may also affect performance.

  11. Outcomes of Safety and Effectiveness in a Multicenter Randomized, Controlled Trial of Whole-Body Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy

    PubMed Central

    Shankaran, Seetha; Pappas, Athina; Laptook, Abbott R.; McDonald, Scott A.; Ehrenkranz, Richard A.; Tyson, Jon E.; Walsh, Michelle; Goldberg, Ronald N.; Higgins, Rosemary D.; Das, Abhik; Network, NICHD Neonatal Research

    2010-01-01

    Background Whole-body hypothermia reduced the frequency of death or moderate/severe disabilities in neonates with hypoxic-ischemic encephalopathy in a randomized, controlled multicenter trial. Objective Our goal was to evaluate outcomes of safety and effectiveness of hypothermia in infants up to 18 to 22 months of age. Design/Methods A priori outcomes were evaluated between hypothermia (n = 102) and control (n = 106) groups. Results Encephalopathy attributable to causes other than hypoxia-ischemia at birth was not noted. Inotropic support (hypothermia, 59% of infants; control, 56% of infants) was similar during the 72-hour study intervention period in both groups. Need for blood transfusions (hypothermia, 24%; control, 24%), platelet transfusions (hypothermia, 20%; control, 12%), and volume expanders (hypothermia, 54%; control, 49%) was similar in the 2 groups. Among infants with persistent pulmonary hypertension (hypothermia, 25%; control, 22%), nitric-oxide use (hypothermia, 68%; control, 57%) and placement on extracorporeal membrane oxygenation (hypothermia, 4%; control, 9%) was similar between the 2 groups. Non–central nervous system organ dysfunctions occurred with similar frequency in the hypothermia (74%) and control (73%) groups. Rehospitalization occurred among 27% of the infants in the hypothermia group and 42% of infants in the control group. At 18 months, the hypothermia group had 24 deaths, 19 severe disabilities, and 2 moderate disabilities, whereas the control group had 38 deaths, 25 severe disabilities, and 1 moderate disability. Growth parameters were similar between survivors. No adverse outcomes were noted among infants receiving hypothermia with transient reduction of temperature below a target of 33.5°C at initiation of cooling. There was a trend in reduction of frequency of all outcomes in the hypothermia group compared with the control group in both moderate and severe encephalopathy categories. Conclusions Although not powered to test

  12. Hypothermia reduces cerebral metabolic rate and cerebral blood flow in newborn pigs

    SciTech Connect

    Busija, D.W.; Leffler, C.W. )

    1987-10-01

    The authors examined effects of hypothermia on cerebral metabolic rate and cerebral blood flow in anesthetized, newborn pigs (1-4 days old). Cerebral blood flow (CBF) was determined with 15-{mu}m radioactive microspheres. Regional CBF ranged from 44 to 66 ml{center dot}min{sup {minus}1}{center dot}100 g{sup {minus}1}, and cerebral metabolic rate was 1.94 {plus minus} 0.23 ml O{sub 2}{center dot}100 g{sup {minus}1}{center dot}min{sup {minus}1} during normothermia (39{degree}C). Reduction of rectal temperature to 34-35{degree}C decreased CBF and cerebral metabolic rate 40-50%. In another group of piglets, they examined responsiveness of the cerebral circulation to arterial hypercapnia during hypothermia. Although absolute values for normocapnic and hypercapnic CBF were reduced by hypothermia and absolute values for normocapnic and hypercapnic cerebrovascular resistance were increased, the percentage changes from control in these variables during hypercapnia were similar during normothermia and hypothermia. In another group of animals that were maintained normothermic and exposed to two episodes of hypercapnia, there was no attenuation of cerebrovascular dilation during the second episode. They conclude that hypothermia reduces CBF secondarily to a decrease in cerebral metabolic rate and that percent dilator responsiveness to arterial hypercapnia is unaltered when body temperature is reduced.

  13. Effect of hypothermia on cell kinetics and response to hyperthermia and x rays

    SciTech Connect

    van Rijn, J.; van den Berg, J.; Kipp, J.B.A.; Schamhart, D.H.J.; van Wijk, R.

    1985-02-01

    Hyperthermia is a potent radio enhancer. Studies using hypothermia in combination with irradiation have given confusing results due to lack of uniformity in experimental design. This report shows that hypothermia might have potential significance in the treatment of malignant cells with both thermo- and radiotherapy. Reuber H35 hepatoma cells, clone KRC-7 were used to study the effect of hypothermia on cell kinetics and subsequent response to hyperthermia and/or X rays. Cells were incubated at 8.5/sup 0/C or between 25 and 37/sup 0/C for 24 hr prior to hyperthermia or irradiation. Hypothermia caused sensitization to both hyperthermia and X rays. In contrast to the effect of hypothermia on either hyperthermia or X rays alone, thermal radiosensitization was decreased in hypothermically pretreated cells (24 hr at 25/sup 0/C) compared to control cells (37/sup 0/C). The expression of thermotolerance and the rate of development at 37/sup 0/C after an initial heating at 42.5/sup 0/C were not influenced after preincubation at 25/sup 0/C for 24 hr. The expression of thermotolerance for heat or heat plus X rays during incubation at 41/sup 0/C occurred in a significantly smaller number of cells after 24 hr preincubation at 25/sup 0/C. The enhanced thermo- and radiosensitivity in hypothermically treated cells disappeared in approximately 6 hr after return to 37/sup 0/C.

  14. Nocturnal hypothermia impairs flight ability in birds: a cost of being cool.

    PubMed

    Carr, Jennie M; Lima, Steven L

    2013-12-01

    Many birds use regulated drops in night-time body temperature (Tb) to conserve energy critical to winter survival. However, a significant degree of hypothermia may limit a bird's ability to respond to predatory attack. Despite this likely energy-predation trade-off, the behavioural costs of avian hypothermia have yet to be examined. We thus monitored the nocturnal hypothermia of mourning doves (Zenaida macroura) in a laboratory setting in response to food deprivation. Nocturnal flight tests were used to quantify the flight ability of hypothermic doves. Many hypothermic doves (39% of tests) could not fly while carrying a small weight, but could do so after quickly warming up to typical daytime Tb. Doves that were unable to fly during their first test were more hypothermic than those that could fly, with average Tb reductions of 5.3°C and 3.3°C, respectively, but there was no overall indication of a threshold Tb reduction beyond which doves were consistently incapable of flight. These results suggest that energy-saving hypothermia interferes with avian antipredator behaviour via a reduction in flight ability, likely leading to a trade-off between energy-saving hypothermia and the risk of predation.

  15. Hypothermia and afterdrop following open water swimming: the Alcatraz/San Francisco Swim Study.

    PubMed

    Nuckton, T J; Claman, D M; Goldreich, D; Wendt, F C; Nuckton, J G

    2000-10-01

    To determine whether or not participants in open water swim events experience hypothermia and afterdrop, rectal temperature was measured for up to 45 minutes in 11 subjects following the New Year's Day Alcatraz Swim. This event was held in open water (11.7 degrees C [53.0 degrees F]) in the San Francisco Bay, and participants did not wear wetsuits or other protective clothing. Biophysical parameters, including surfacelvolume ratio, body mass index, and percent body fat were measured before the swim, and statistical analysis was done to determine predictors of temperature decrease and afterdrop duration. Applying the American Heart Association definition of hypothermia (less than 36.0 C [96.8 degrees F]), hypothermia was seen in 5 of the 11 subjects. Using a more rigorous and traditional definition (less than 35.0 degrees C [95.0 degrees F]), hypothermia was seen in only one subject. Afterdrop, defined as continued cooling following removal from cold stress, was seen in 10 of the 11 subjects. Surface/volume ratio (S/V) and body mass index (BMI) predicted the lowest recorded temperatures (P < .05; r(S/V) = -.71, r(BMI) = .72) and afterdrop duration (P < .05; r(SN) = -.75, r(BMI) = .69). These results suggest that hypothermia and afterdrop can occur commonly after recreational open water swimming, and that participants should be observed for signs of temperature decrease following removal from cold stress. PMID:11043627

  16. The Physiologic Effects of Isoflurane, Sevoflurane, and Hypothermia Used for Anesthesia in Neonatal Rats (Rattus norvegicus)

    PubMed Central

    Huss, Monika K; Chum, Helen H; Chang, Angela G; Jampachairsi, Katechan; Pacharinsak, Cholawat

    2016-01-01

    Information regarding effective anesthetic regimens for neonatal rat pups is limited. Here we investigated whether isoflurane or sevoflurane anesthesia maintains physiologic parameters more consistently than does hypothermia anesthesia in neonatal rat pups. Rat pups (age, 4 d) were randomly assigned to receive isoflurane, sevoflurane, or hypothermia. Physiologic parameters monitored at 1, 5, 10, and 15 min included heart rate (HR), respiratory rate (RR), and oxygen saturation (%SpO2). Other parameters evaluated were loss and return of righting reflex, paw withdrawal reflex, and maternal acceptance. Corticosterone and glucose were sampled at 20 min and 24 h after anesthesia induction. Once a surgical plane of anesthesia was achieved, a skin incision was made on the right lateral thigh. After the procedure, all pups were accepted and cared for by their dam. Isoflurane- and sevoflurane-treated pups maintained higher HR, RR, %SpO2, and glucose levels than did hypothermia-treated pups. For both the isoflurane and sevoflurane groups, HR and RR were significantly lower at 10 and 15 min after anesthesia than at 1 min. Compared with hypothermia, isoflurane and sevoflurane anesthesia provided shorter times to loss of and return of the righting reflex. Although corticosterone did not differ among the groups, glucose levels were higher at 20 min after anesthesia induction than at 24 h in all anesthetic groups. We conclude that both isoflurane and sevoflurane anesthesia maintain physiologic parameters (HR, RR, %SpO2) more consistently than does hypothermia anesthesia in 4-d-old rat pups. PMID:26817984

  17. Neuroprotective effect of epidural hypothermia after spinal cord lesion in rats

    PubMed Central

    Barbosa, Marcello Oliveira; Cristante, Alexandre Fogaça; dos Santos, Gustavo Bispo; Ferreira, Ricardo; Marcon, Raphael Martus; de Barros Filho, Tarcisio Eloy Pessoa

    2014-01-01

    OBJECTIVES : To evaluate the neuroprotective effect of epidural hypothermia in rats subjected to experimental spinal cord lesion. METHODS: Wistar rats (n = 30) weighing 320-360 g were randomized to two groups (hypothermia and control) of 15 rats per group. A spinal cord lesion was induced by the standardized drop of a 10-g weight from a height of 2.5 cm, using the New York University Impactor, after laminectomy at the T9-10 level. Rats in the hypothermia group underwent epidural hypothermia for 20 minutes immediately after spinal cord injury. Motor function was assessed for six weeks using the Basso, Beattie and Bresnahan motor scores and the inclined plane test. At the end of the final week, the rats' neurological status was monitored by the motor evoked potential test and the results for the two groups were compared. RESULTS: Analysis of the Basso, Beattie and Bresnahan scores obtained during the six-week period indicated that there were no significant differences between the two groups. There was no significant difference between the groups in the inclined plane test scores during the six-week period. Furthermore, at the end of the study, the latency and amplitude values of the motor evoked potential test were not significantly different between the two groups. CONCLUSION: Hypothermia did not produce a neuroprotective effect when applied at the injury level and in the epidural space immediately after induction of a spinal cord contusion in Wistar rats. PMID:25141116

  18. Locally induced hypothermia for treatment of acute ischaemic stroke: a physical feasibility study.

    PubMed

    Slotboom, J; Kiefer, C; Brekenfeld, C; Ozdoba, C; Remonda, L; Nedeltchev, K; Arnold, M; Mattle, H; Schroth, G

    2004-11-01

    During the treatment of stroke by local intra-arterial thrombolysis (LIT) it is frequently possible to pass the blood clot with a micro-catheter, allowing perfusion of brain tissue distally to the occlusion. This possibility allows for new early treatments of ischaemic brain tissue, even before the blood clot has been removed. One potential new approach to preserve brain tissue at risk may be locally induced endovascular hypothermia. Physical parameters such as the required micro-catheter input pressure, output velocity and flow rates, and a heat exchange model, applicable in the case of a micro-catheter placed within a guiding catheter, are presented. Also, a simple cerebral temperature model is derived that models the temperature response of the brain to the perfusion with coolant fluids. Based on this model, an expression has been derived for the time needed to reach a certain cerebral target temperature. Experimental in vitro measurements are presented that confirm the usability of standard commercially available micro-catheters to induce local hypothermia of the brain. If applied in vivo, the model predicts a local cooling rate of ischaemic brain tissue of 300 g of approximately 1 degrees C in 1 min, which is up to a factor 30-times faster than the time-consuming systemic hypothermia via the skin. Systemic body temperature is only minimally affected by application of local hypothermia, thus avoiding many limitations and complications known in systemic hypothermia. PMID:15551092

  19. Nocturnal hypothermia impairs flight ability in birds: a cost of being cool

    PubMed Central

    Carr, Jennie M.; Lima, Steven L.

    2013-01-01

    Many birds use regulated drops in night-time body temperature (Tb) to conserve energy critical to winter survival. However, a significant degree of hypothermia may limit a bird's ability to respond to predatory attack. Despite this likely energy–predation trade-off, the behavioural costs of avian hypothermia have yet to be examined. We thus monitored the nocturnal hypothermia of mourning doves (Zenaida macroura) in a laboratory setting in response to food deprivation. Nocturnal flight tests were used to quantify the flight ability of hypothermic doves. Many hypothermic doves (39% of tests) could not fly while carrying a small weight, but could do so after quickly warming up to typical daytime Tb. Doves that were unable to fly during their first test were more hypothermic than those that could fly, with average Tb reductions of 5.3°C and 3.3°C, respectively, but there was no overall indication of a threshold Tb reduction beyond which doves were consistently incapable of flight. These results suggest that energy-saving hypothermia interferes with avian antipredator behaviour via a reduction in flight ability, likely leading to a trade-off between energy-saving hypothermia and the risk of predation. PMID:24107528

  20. The Need for More Prehospital Research on Language Barriers: A Narrative Review

    PubMed Central

    Tate, Ramsey C.

    2015-01-01

    Introduction Despite evidence from other healthcare settings that language barriers negatively impact patient outcomes, the literature on language barriers in emergency medical services (EMS) has not been previously summarized. The objective of this study is to systematically review existing studies of the impact of language barriers on prehospital emergency care and identify opportunities for future research. Methods A systematic review with narrative synthesis of publications with populations specific to the prehospital setting and outcome measures specific to language barriers was conducted. A four-prong search strategy of academic databases (PubMed, Academic Search Complete, and Clinical Key) through March 2015, web-based search for gray literature, search of citation lists, and review of key conference proceedings using pre-defined eligibility criteria was used. Language-related outcomes were categorized and reported as community-specific outcomes, EMS provider-specific outcomes, patient-specific outcomes, or health system-specific outcomes. Results Twenty-two studies met eligibility criteria for review. Ten publications (45%) focused on community-specific outcomes. Language barriers are perceived as a barrier by minority language speaking communities to activating EMS. Eleven publications (50%) reported outcomes specific to EMS providers, with six of these studies focused on EMS dispatch. EMS dispatchers describe less accurate and delayed dispatch of resources when confronted with language discordant callers, as well as limitations in the ability to provide medical direction to callers. There is a paucity of research on EMS treatment and transport decisions, and no studies provided patient-specific or health system-specific outcomes. Key research gaps include identifying the mechanisms by which language barriers impact care, the effect of language barriers on EMS utilization and clinically significant outcomes, and the cost implications of addressing language

  1. Effects of mild hypothermia therapy on the levels of glutathione in rabbit blood and cerebrospinal fluid after cardiopulmonary resuscitation

    PubMed Central

    Zhao, Hui; Chen, Yueliang

    2015-01-01

    Objective(s): The aim of this study was to investigate the effects of mild hypothermia therapy on oxidative stress injury of rabbit brain tissue after cardiopulmonary resuscitation (CPR). Materials and Methods: Rabbit models of cardiac arrest were established. After the restoration of spontaneous circulation, 50 rabbits were randomly divided into normothermia and hypothermia groups. The following five time points were selected: before CPR, immediately after CPR, 2 hr after CPR (hypothermia group reached the target temperature), 14 hr after CPR (hypothermia group before rewarming), and 24 hr after CPR (hypothermia group recovered to normal temperature). Glutathione (GSH) concentrations in both the blood and cerebrospinal fluid of the normothermia and hypothermia groups were measured. Results: At 2, 14, and 24 hr after CPR, the GSH concentrations in both the blood and cerebrospinal fluid were significantly higher in the hypothermia group than in the nomorthermia group. Conclusion: Mild hypothermia therapy may increase GSH concentrations in rabbit blood and cerebrospinal fluid after CPR as well as promote the recovery of cerebral function. PMID:25810895

  2. Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients

    PubMed Central

    Patel, Archita D.; Meurer, David A.; Shuster, Jonathan J.

    2016-01-01

    Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training. Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression. Crews were asked to rate their confidence levels before and after exposure to the scenarios. Timing of the simulation interventions was compared with actual scene times to determine applicability of simulation in measuring the efficiency of prehospital personnel. Results. Results were collected from 129 participants. Pre- and postexposure scores increased by a mean of 1.15 (SD 1.32; 95% CI, 0.88–1.42; P < 0.001). Comparison of actual scene times with simulated scene times yielded a 1.39-fold difference (95% CI, 1.25–1.55) for Scenario 1 and 1.59 times longer for Scenario 2 (95% CI, 1.43–1.77). Conclusion. Simulation training improved prehospital care providers' confidence level in performing two life-saving procedures. PMID:27563467

  3. Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients.

    PubMed

    Van Dillen, Christine M; Tice, Matthew R; Patel, Archita D; Meurer, David A; Tyndall, Joseph A; Elie, Marie Carmelle; Shuster, Jonathan J

    2016-01-01

    Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training. Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression. Crews were asked to rate their confidence levels before and after exposure to the scenarios. Timing of the simulation interventions was compared with actual scene times to determine applicability of simulation in measuring the efficiency of prehospital personnel. Results. Results were collected from 129 participants. Pre- and postexposure scores increased by a mean of 1.15 (SD 1.32; 95% CI, 0.88-1.42; P < 0.001). Comparison of actual scene times with simulated scene times yielded a 1.39-fold difference (95% CI, 1.25-1.55) for Scenario 1 and 1.59 times longer for Scenario 2 (95% CI, 1.43-1.77). Conclusion. Simulation training improved prehospital care providers' confidence level in performing two life-saving procedures. PMID:27563467

  4. [Severe apparent life-threatening event during "skin-to-skin": treatment with hypothermia].

    PubMed

    Marin, N; Valverde, E; Cabañas, F

    2013-10-01

    'Skin-to-skin' in healthy newborn infants is currently routine practice in Spanish maternity wards. This practice has shown benefits in increasing the duration of breast-feeding and maternal bonding behaviour with no significant adverse events. Early sudden deaths and severe apparent life-threatening events (ALTE) during the first 24 hours of life are infrequent, but well recognised. Risk factors during 'skin to skin' have been established. These events can lead to high neonatal morbidity and mortality. Hypothermia is now the standard of care for moderate to severe hypoxic-ischaemic encephalopathy and has shown to reduce mortality and neurological morbidity in children with hypoxic-ischaemic brain injury. Although there are no clinical trials that evaluate hypothermia after a severe ALTE, neonates who suffer it should be considered for this treatment. We present a case of a healthy newborn who had an ALTE during skin-to-skin with his mother and was treated with hypothermia.

  5. Effects of methamphetamine and methyldopa on ethanol induced hypothermia in mice.

    PubMed

    Ageel, A M; Ginawi, O T

    1985-02-01

    The effects of D-methamphetamine HCl (1, 2 and 4 mg/kg, i.p.) and alpha-methyldopa (1, 2 and 4 mg/kg, i.p.) on rectal temperature and on ethanol (3 g/kg, i.p.)-induced hypothermia have been investigated in mice. Methamphetamine caused a dose-dependent hyperthermia, but methyldopa induced hypothermia, which decreased with increases in dose. Methamphetamine antagonized the hypothermic effect of ethanol, but methyldopa (1 and 2 mg/kg) did not affect it. Methyldopa (4 mg/kg), however, reversed ethanol hypothermia. Ethanol pretreatment significantly potentiated the hypothermic effect of methyldopa (4 mg/kg), and it prevented methamphetamine-induced hyperthermia. A possible central action for the tested drugs on biogenic monoamines and a peripheral component in their thermoregulatory effects are discussed in this report.

  6. Perioperative hypothermia and incidence of surgical wound infection: a bibliographic study

    PubMed Central

    da Silva, Aline Batista; Peniche, Aparecida de Cassia Giani

    2014-01-01

    The purpose of this review article was to understand and analyze the scientific production related to the occurrence of perioperative hypothermia and the incidence of infection on the surgical site. For this purpose, a search was conducted in the databases LILACS, MEDLINE, PubMed, CINAHL and Cochrane, using the health science descriptors DECS, from 2004 to 2009. A total of 91 articles were found. After eliminating duplicate items and using selection criteria for inclusion, six manuscripts remained for analysis. The studies were classified as retrospective, prospective, case studies, and clinical trials. After analysis, the majority of studies showed that hypothermia must be prevented during the perioperative period to reduce complications in the healing process of the surgical incision. Therefore, unadverted hypothermia directly influences in surgical site healing, increasing the incidence of infection in the surgical wound. PMID:25628208

  7. [Severe apparent life-threatening event during "skin-to-skin": treatment with hypothermia].

    PubMed

    Marin, N; Valverde, E; Cabañas, F

    2013-10-01

    'Skin-to-skin' in healthy newborn infants is currently routine practice in Spanish maternity wards. This practice has shown benefits in increasing the duration of breast-feeding and maternal bonding behaviour with no significant adverse events. Early sudden deaths and severe apparent life-threatening events (ALTE) during the first 24 hours of life are infrequent, but well recognised. Risk factors during 'skin to skin' have been established. These events can lead to high neonatal morbidity and mortality. Hypothermia is now the standard of care for moderate to severe hypoxic-ischaemic encephalopathy and has shown to reduce mortality and neurological morbidity in children with hypoxic-ischaemic brain injury. Although there are no clinical trials that evaluate hypothermia after a severe ALTE, neonates who suffer it should be considered for this treatment. We present a case of a healthy newborn who had an ALTE during skin-to-skin with his mother and was treated with hypothermia. PMID:24051185

  8. Severe brain hypothermia as a factor underlying behavioral immobility during cold-water forced swim.

    PubMed

    Taltavull, J F; Chefer, V I; Shippenberg, T S; Kiyatkin, E A

    2003-06-13

    Behavioral immobility during forced swim is usually considered a consequence of inescapable stress, and is used to screen antidepressant drugs. However, immobility in this test may also result from inhibition of neural functions because of brain hypothermia due to body cooling. To explore this possibility, we measured brain temperature dynamics during a 10-min forced swim in cold (25 degrees C) and warm (37 degrees C) water and correlated brain temperatures with behavioral changes. Cold water forced swim resulted in significant brain hypothermia (-6-7 degrees C) and immobility, while no immobility was observed during warm water forced swim, when brain temperature transiently increased (0.5 degrees C) then decreased below baseline in the post-swim period. These data suggest that immobility, which rapidly develops during forced swim in cold water, may result from dramatic inhibition of neural functions because of severe brain hypothermia.

  9. Involvement of histamine H1 and H2 receptors in hypothermia induced by ionizing radiation in guinea pigs

    SciTech Connect

    Kandasamy, S.B.; Hunt, W.A.

    1988-01-01

    Radiation-induced hypothermia was examined in guinea pigs. Exposure to the head alone or whole-body irradiation-induced hypothermia, whereas exposure of the body alone produced a small insignificant response. Systemic injection of disodium cromoglycate (a mast cell stabilizer) and cimetidine (H2-receptor antagonist) had no effect on radiation-induced hypothermia, whereas systemic and central administration of mepyramine (H1-receptor antagonist) or central administration disodium cromoglycate or cimetidine attenuated it, indicating the involvement of central histamine through both H1 and H2 receptors in this response. Serotonin is not involved, since the serotonin antagonist methysergide had no effect on radiation-induced hypothermia. These results indicate that central histaminergic systems may be involved in radiation-induced hypothermia.

  10. Neuroprotective effects of cold-inducible RNA-binding protein during mild hypothermia on traumatic brain injury

    PubMed Central

    Wang, Guan; Zhang, Jian-ning; Guo, Jia-kui; Cai, Ying; Sun, Hong-sheng; Dong, Kun; Wu, Cheng-gang

    2016-01-01

    Cold-inducible RNA-binding protein (CIRP), a key regulatory protein, could be facilitated by mild hypothermia in the brain, heart and liver. This study observed the effects of mild hypothermia at 31 ± 0.5°C on traumatic brain injury in rats. Results demonstrated that mild hypothermia suppressed apoptosis in the cortex, hippocampus and hypothalamus, facilitated CIRP mRNA and protein expression in these regions, especially in the hypothalamus. The anti-apoptotic effect of mild hypothermia disappeared after CIRP silencing. There was no correlation between mitogen-activated extracellular signal-regulated kinase activation and CIRP silencing. CIRP silencing inhibited extracellular signal-regulated kinase-1/2 activation. These indicate that CIRP inhibits apoptosis by affecting extracellular signal-regulated kinase-1/2 activation, and exerts a neuroprotective effect during mild hypothermia for traumatic brain injury. PMID:27335561

  11. Involvement of histamine H1 and H2 receptors in hypothermia induced by ionizing radiation in guinea pigs

    SciTech Connect

    Kandasamy, S.B.; Hunt, W.A.

    1988-01-01

    Radiation-induced hypothermia was examined in guinea pigs. Exposure to the head alone or whole-body irradiation induced hypothermia, whereas exposure of the body alone produced a small insignificant response. Systemic injection of disodium cromoglycate (a mast cell stabilizer) and cimetidine (H2-receptor antagonist) had no effect on radiation-induced hypothermia, whereas systemic and central administration of mepyramine (H1-receptor antagonist) or central administration of disodium cromoglycate or cimetidine attenuated it, indicating the involvement of central histamine through both H1 and H2 receptors in this response. Serotonin is not involved, since the serotonin antagonist methysergide had no effect on radiation-induced hypothermia. These results indicate that central histaminergic systems may be involved in radiation-induced hypothermia. 34 references, 5 figures, 2 tables.

  12. Dose-dependent effects of levetiracetam after hypoxia and hypothermia in the neonatal mouse brain.

    PubMed

    Strasser, Katja; Lueckemann, Laura; Kluever, Verena; Thavaneetharajah, Sinthuya; Hoeber, Daniela; Bendix, Ivo; Fandrey, Joachim; Bertsche, Astrid; Felderhoff-Mueser, Ursula

    2016-09-01

    Perinatal asphyxia to the developing brain remains a major cause of morbidity. Hypothermia is currently the only established neuroprotective treatment available for term born infants with hypoxic-ischemic encephalopathy, saving one in seven to eight infants from developing severe neurological deficits. Therefore, additional treatments with clinically applicable drugs are indispensable. This study investigates a potential additive neuroprotective effect of levetiracetam combined with hypothermia after hypoxia-induced brain injury in neonatal mice. 9-day-old C57BL/6-mice (P9) were subjected either to acute hypoxia or room-air. After 90min of systemic hypoxia (6% O2), pups were randomized into six groups: 1) vehicle, 2) low-dose levetiracetam (LEV), 3) high-dose LEV, 4) hypothermia (HT), 5) HT combined with low-dose LEV and 6) HT combined with high-dose LEV. Pro-apoptotic factors, neuronal structures, and myelination were analysed by histology and on protein level at appropriate time points. On P28 to P37 long-term outcome was assessed by neurobehavioral testing. Hypothermia confers acute and long-term neuroprotection by reducing apoptosis and preservation of myelinating oligodendrocytes and neurons in a model of acute hypoxia in the neonatal mouse brain. Low-dose LEV caused no adverse effects after neonatal hypoxic brain damage treated with hypothermia whereas administration of high-dose LEV alone or in combination with hypothermia increased neuronal apoptosis after hypoxic brain injury. LEV in low- dosage had no additive neuroprotective effect following acute hypoxic brain injury. PMID:27216570

  13. Failure of delayed and prolonged hypothermia to favorably affect hemorrhagic stroke in rats.

    PubMed

    MacLellan, Crystal; Shuaib, Ashfaq; Colbourne, Frederick

    2002-12-20

    Prolonged hypothermia reduces global and focal cerebral ischemic injury in rodents even when delayed for hours. However, it is not known whether hypothermia can reduce injury following intracerebral hemorrhage (ICH). Accordingly, we studied striatal injury and concomitant motor deficits after 2 days of hypothermia, induced 1 h after creation of an ICH by infusion of bacterial collagenase. Rats were first trained to retrieve food pellets in the Montoya staircase task. They were then implanted with core temperature telemetry probes and later subjected to normothermic ICH or sham operation (vehicle injection). Half self-regulated temperature after surgery; others were cooled to 33 degrees C (24 h) and then 35 degrees C (24 h). Hypothermia did not affect behavioral scores of sham animals (89.8% of baseline in staircase test) or histology. Untreated (normothermic) ICH rats lost 23.1 mm(3) of tissue at a 1-month survival, which significantly impaired food pellet retrieval (66.0% retrieval) with the contralateral limb (tested on days 21-25). Contrary to our hypothesis, hypothermia failed to lessen either the reaching impairment (62.8%) or the lesion (22.2 mm(3)). While other hemorrhagic insults or complications may be improved with hypothermia, our data suggest that it will not salvage tissue that is quickly lost after ICH. We also assessed walking across a horizontal ladder and spontaneous paw usage in a cylinder test at 1-4 weeks after ICH, but neither test was sufficiently sensitive to this mild insult. This indicates that skilled reaching is more severely disrupted than spontaneous paw usage or walking after a striatal hemorrhage. PMID:12468045

  14. Wet-cold exposure and hypothermia: thermal and metabolic responses to prolonged exercise in rain.

    PubMed

    Thompson, R L; Hayward, J S

    1996-09-01

    Simulated conditions of hiking in rain, wind, and cold, without protective rainwear, were used to investigate wet-cold hypothermia in 18 male subjects. Thermal, metabolic, and motor responses were monitored during an attempted 5-h walk (5.1 km/h) at 5 degrees C, with continuous exposure to rain (7.4 cm/h) and wind (8.0 km/h) over the final 4 h. The majority of subjects (11) could not complete the protocol because of intolerance of wet-cold conditions during the last 2 h. Therefore, data from 5 subjects who completed the protocol in rain and control conditions were used to describe the general pattern of response. During the 1st h of walking, core temperature rose 1 degree C to 38.1 degrees C. The subsequent 2 h of rain caused substantial cold stress, indicated by a 40% increase in heat production due to shivering and significant loss of strength and manual dexterity. However, core temperature only decreased to 37.1 degrees C, merely eliminating the initial exercise hyperthermia. Over the last 2 h of rain, core temperature remained relatively stable at 36.8 degrees C, decreasing slightly to 36.4 degrees C by 5 h. Two other subjects developed significant hypothermia (35 degrees C). One demonstrated fatigue of shivering after 2.5 h of rain, confirming the exhaustion hypothesis of wet-cold hypothermia. The older cooled rapidly when he failed to maintain the walking pace. We conclude that if a person can tolerate the intense discomfort of prolonged wet-cold exposure, he or she has the potential to resist significant core hypothermia for at least 4 h of walking under the conditions of this experiment. Exceptions to this generalization occur, making exposure of < 4 h a hypothermia risk for some individuals. Exposures > 4 h would involve increasing probability of rapid decline into hypothermia, associated with exhaustion of shivering and exercise heat production.

  15. Electroencephalography during surgery with cardiopulmonary bypass and hypothermia.

    PubMed

    Bashein, G; Nessly, M L; Bledsoe, S W; Townes, B D; Davis, K B; Coppel, D B; Hornbein, T F

    1992-06-01

    After more than 30 yr of use, electroencephalographic (EEG) monitoring during cardiopulmonary bypass has not gained wide clinical acceptance. To assess its utility to predict central nervous system injury, two-channel recordings were made from 78 patients undergoing cardiopulmonary bypass and anesthetized with fentanyl/diazepam/enflurane. The perfusion regimen included the use of high pump flow, a bubble oxygenator, and no arterial tubing filter. Target values were 28-32 degrees C for the minimum rectal temperature, 60-80 mmHg for mean arterial pressure, and 20-25% for hematocrit. Eight descriptors of the Fourier power spectra of the EEG were calculated off-line, and outcome comparisons were made with the results from neuropsychological tests. Among 58 patients yielding complete data of acceptable quality, a statistically significant reduction in total power was observed from prebypass to postbypass, accompanied by an increase in the fractional power in the theta and beta frequency bands and in the spectral edge frequency. The shifts in total and theta power were weakly associated with short-term but not with long-term changes in neuropsychological scores. Nearly 40% of the patients' EEGs were corrupted with electrical noise at some time during bypass. In 15 patients selected for having high-quality recordings and no neuropsychological deficit, an extensive statistical analysis failed to reveal any consistent variation in the EEG descriptors with hypothermia. Under the conditions studied, it appears that for other than gross signal dropout, the strong background variability in the EEG makes it have little value for detecting harbingers of brain injury.

  16. Effect of enhanced geomagnetic activity on hypothermia and mortality in rats

    NASA Astrophysics Data System (ADS)

    Bureau, Y. R. J.; Persinger, M. A.; Parker, G. H.

    1996-12-01

    The hypothesis was investigated that variability in the severity of limbic seizure-induced hypothermia in rats was affected by ambient geomagnetic activity. Data were obtained in support of this hypothesis. The depth of the hypothermia was significantly ( P < 0.001) reduced if the ambient geomagnetic activity exceeded 35 nT to 40 nT. Mortality during the subsequent 5 days was increased when the geomagnetic activity was > 20 nT. The magnitude of the effect was comparable to the difference between exposure to light or to darkness during the 20 h after the induction of limbic seizures.

  17. Effects of kainic acid on hypothermia induced by reserpine, oxotremorine and apomorphine in mice.

    PubMed

    Bourin, M; Poisson, L; Larousse, C

    1987-03-01

    Antagonists of the norepinephrine reuptake and beta-adrenoreceptor agonists are potent, at once, on the three following tests: antagonism of hypothermia induced by reserpine, oxotremorine and apomorphine. 2-Carboxy-4-isopropenyl-3-pyrrolidine-acetic acid (kainic acid), which is a powerful stimulant of the neurons and a destroyer of the dopaminergic neurons, has been used in these tests to show if it is possible to antagonize hypothermia induced by different substances. The results obtained show that kainic acid is potent on these three tests, thus providing evidence that it is a stimulant of norepinephrine neurons as well as serotoninergic neurons, even if it is peripherically injected.

  18. Intravenous access during pre-hospital emergency care of non-injured patients: a population-based outcome study

    PubMed Central

    Seymour, Christopher W.; Cooke, Colin R.; Hebert, Paul L.; Rea, Thomas D.

    2011-01-01

    Study objective Advanced, pre-hospital procedures such as intravenous access are commonly performed by emergency medical services (EMS) personnel, yet little evidence supports their use among non-injured patients. We evaluated the association between pre-hospital, intravenous access and mortality among non-injured, non-arrest patients. Methods We analyzed a population-based cohort of adult (aged ≥18 years) non-injured, non-arrest patients transported by four advanced life support agencies to one of 16 hospitals from January 1, 2002 until December 31, 2006. We linked eligible EMS records to hospital administrative data, and used multivariable logistic regression to determine the risk-adjusted association between pre-hospital, intravenous access and hospital mortality. We also tested whether this association differed by patient acuity using a previously published, out-of-hospital triage score. Results Among 56,332 eligible patients, one half (N=28,978, 50%) received pre-hospital intravenous access from EMS personnel. Overall hospital mortality in patients who did and did not receive intravenous access was 3%. However, in multivariable analyses, the placement of pre-hospital, intravenous access was associated with an overall reduction in odds of hospital mortality (OR=0.68, 95%CI: 0.56, 0.81). The beneficial association of intravenous access appeared to depend on patient acuity (p=0.13 for interaction). For example, the OR of mortality associated with intravenous access was 1.38 (95%CI: 0.28, 7.0) among those with lowest acuity (score = 0). In contrast, the OR of mortality associated with intravenous access was 0.38 (95%CI: 0.17, 0.9) among patients with highest acuity (score ≥ 6). Conclusions In this population-based cohort, pre-hospital, intravenous access was associated with a reduction in hospital mortality among non-injured, non-arrest patients with the highest acuity. PMID:21872970

  19. Successful fibrinolytic and therapeutic hypothermic management of cardiac arrest following massive pulmonary embolism

    PubMed Central

    Ko, Eunsil; Lee, Jeong Hoon; Chae, Minjung Kathy; Lee, Tae Rim; Sim, Min Seob; Shin, Tae Gun; Cha, Won Chul; Jo, Ik Joon; Song, Keun Jeong; Rhee, Joong Eui; Jeong, Yeon Kwon

    2015-01-01

    Massive pulmonary embolism (MPE) with hemodynamic instability is a clinical condition with a poor prognosis and high mortality rates. There are no definitive treatment options for cardiac arrest due to MPE. A 52-year-old female presented at our emergency department with cardiac arrest, and a 62-year-old female presented after achieving return of spontaneous circulation of cardiac arrest from a local hospital, respectively. In each case, computed tomographic pulmonary angiography after return of spontaneous circulation demonstrated heavy burdens of pulmonary embolism in the pulmonary arteries. We immediately started therapeutic hypothermia and fibrinolytic therapy. They were transferred to the thoracic surgery and cardiology departments respectively, and then discharged with a cerebral performance categories scale score of 1. In summary, we report two cases of out-of-hospital cardiac arrest due to MPE in which fibrinolytic therapy was successfully combined with therapeutic hypothermia. PMID:27752597

  20. [Protocols for trauma care and the missing of injuries in severely injured accident victims during the prehospital phase].

    PubMed

    van Vugt, A B

    2006-10-01

    Standardizing trauma care according to internationally accepted life-support principles is being increasingly implemented in the prehospital as well as the intramural setting. In the primary survey it is important to distinguish between aspects of major and minor importance, without losing sight of details. In prehospital care it is of little use to be focused on the complete diagnoses and the approach should be related to signs and symptoms. First attention should be paid to the mechanism of injury, related potential vital impairment and obvious visible injuries. The goal should be effective treatment, focused on the stabilization of vital functions and triage related to the choice of facility necessary for definitive care.

  1. A consensus based template for reporting of pre-hospital major incident medical management

    PubMed Central

    2014-01-01

    Background Structured reporting of major incidents has been advocated to improve the care provided at future incidents. A systematic review identified ten existing templates for reporting major incident medical management, but these templates are not in widespread use. We aimed to address this challenge by designing an open access template for uniform reporting of data from pre-hospital major incident medical management that will be tested for feasibility. Methods An expert group of thirteen European major incident practitioners, planners or academics participated in a four stage modified nominal group technique consensus process to design a novel reporting template. Initially, each expert proposed 30 variables. Secondly, these proposals were combined and each expert prioritized 45 variables from the total of 270. Thirdly, the expert group met in Norway to develop the template. Lastly, revisions to the final template were agreed via e-mail. Results The consensus process resulted in a template consisting of 48 variables divided into six categories; pre-incident data, Emergency Medical Service (EMS) background, incident characteristics, EMS response, patient characteristics and key lessons. Conclusions The expert group reached consensus on a set of key variables to report the medical management of pre-hospital major incidents and developed a novel reporting template. The template will be freely available for downloading and reporting on http://www.majorincidentreporting.org. This is the first global open access database for pre-hospital major incident reporting. The use of a uniform dataset will allow comparative analysis and has potential to identify areas of improvement for future responses. PMID:24517242

  2. A Randomized Clinical Trial to Reduce Patient Prehospital Delay to Treatment in Acute Coronary Syndrome

    PubMed Central

    Dracup, Kathleen; McKinley, Sharon; Riegel, Barbara; Moser, Debra K.; Meischke, Hendrika; Doering, Lynn V.; Davidson, Patricia; Paul, Steven M.; Baker, Heather; Pelter, Michele

    2009-01-01

    Background Delay from onset of acute coronary syndrome (ACS) symptoms to hospital admission continues to be prolonged. To date community education campaigns on the topic have had disappointing results. Therefore, we conducted a clinical randomized trial to test whether an intervention tailored specifically for patients with ACS and delivered one-on-one would reduce pre-hospital delay time. Methods and Results Participants (N=3522) with documented coronary heart disease were randomized to experimental (n=1777) or control (n=1745) groups. Experimental patients received education and counseling about ACS symptoms and actions required. Patients were mean age 67±11 years and 68% were male. Over the two years of follow-up, 565 patients (16.0%) were admitted to an emergency department with ACS symptoms a total of 842 times. Neither median prehospital delay time (experimental 2.20 vs. control 2.25 hours) nor emergency medical system use (experimental 63.6% vs. control 66.9%) was different between groups, although experimental patients were more likely than control to call the emergency medical system if the symptoms occurred within the first 6 months following the intervention (p=0.036). Experimental patients were significantly more likely to take aspirin following symptom onset than control patients (experimental 22.3% vs. control 10.1%, p=0.02). The intervention did not result in an increase in emergency department utilization (experimental 14.6% vs. control 17.5%) Conclusions The education and counseling intervention did not lead to reduced pre-hospital delay or increased ambulance use. Reducing the time from onset of acute coronary syndrome symptoms to arrival at the hospital continues to be a significant public health challenge. PMID:20031889

  3. Lightweight physiologic sensor performance during pre-hospital care delivered by ambulance clinicians.

    PubMed

    Mort, Alasdair J; Fitzpatrick, David; Wilson, Philip M J; Mellish, Chris; Schneider, Anne

    2016-02-01

    The aim of this study was to explore the impact of motion generated by ambulance patient management on the performance of two lightweight physiologic sensors. Two physiologic sensors were applied to pre-hospital patients. The first was the Contec Medical Systems CMS50FW finger pulse oximeter, monitoring heart rate (HR) and blood oxygen saturation (SpO2). The second was the RESpeck respiratory rate (RR) sensor, which was wireless-enabled with a Bluetooth(®) Low Energy protocol. Sensor data were recorded from 16 pre-hospital patients, who were monitored for 21.2 ± 9.8 min, on average. Some form of error was identified on almost every HR and SpO2 trace. However, the mean proportion of each trace exhibiting error was <10 % (range <1-50 % for individual patients). There appeared to be no overt impact of the gross motion associated with road ambulance transit on the incidence of HR or SpO2 error. The RESpeck RR sensor delivered an average of 4.2 (±2.2) validated breaths per minute, but did not produce any validated breaths during the gross motion of ambulance transit as its pre-defined motion threshold was exceeded. However, this was many more data points than could be achieved using traditional manual assessment of RR. Error was identified on a majority of pre-hospital physiologic signals, which emphasised the need to ensure consistent sensor attachment in this unstable and unpredictable environment, and in developing intelligent methods of screening out such error.

  4. Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population

    PubMed Central

    Welch, Robert D.; Nicholas, Katherine; Durkalski-Mauldin, Valerie L.; Lowenstein, Daniel H.; Conwit, Robin; Mahajan, Prashant V.; Lewandowski, Christopher; Silbergleit, Robert

    2015-01-01

    Summary Objective To examine the effectiveness of intramuscular (IM) midazolam versus intravenous (IV) lorazepam for the treatment of pediatric patients with status epilepticus (SE) in the prehospital care setting. Methods This multicenter clinical trial randomized patients diagnosed with SE to receive either IM midazolam or IV lorazepam administered by paramedics in the prehospital care setting. Included in this secondary analysis were only patients younger than 18 years of age. Evaluated were the associations of the treatment group (IM vs. IV) with the primary outcome, defined as seizure cessation prior to emergency department (ED) arrival, and with patient characteristics, time to important events, and adverse events. Descriptive statistics and 99% confidence intervals (CIs) were used for the analysis. Results Of 893 primary study subjects, 120 met criteria for this study (60 in each treatment group). There were no differences in important baseline characteristics or seizure etiologies between groups. The primary outcome was met in 41 (68.3%) and 43 (71.7%) of subjects in the IM and IV groups, respectively (risk difference [RD] −3.3%, 99% CI −24.9% to 18.2%). Similar results were noted for those younger than 11 years (RD −1.3%, 99% CI −25.7% to 23.1%). Time from initiating the treatment protocol was shorter for children who received IM midazolam, mainly due to the shorter time to administer the active treatment. Safety profiles were similar. Significance IM midazolam can be rapidly administered and appears to be safe and effective for the management of children with SE treated in the prehospital setting. The results must be interpreted in the context of the secondary analysis design and sample size of the study. PMID:25597369

  5. Prehospital Management of Gunshot Patients at Major Trauma Care Centers: Exploring the Gaps in Patient Care

    PubMed Central

    Norouzpour, Amir; Khoshdel, Ali Reza; Modaghegh, Mohammad-Hadi; Kazemzadeh, Gholam-Hossein

    2013-01-01

    Background Prehospital management of gunshot-wounded (GW) patients influences injury-induced morbidity and mortality. Objectives To evaluate prehospital management to GW patients emphasizing the protocol of patient transfer to appropriate centers. Patients and Methods This prospective study, included all GW patients referred to four major, level-I hospitals in Mashhad, Iran. We evaluated demographic data, triage, transport vehicles of patients, hospitalization time and the outcome. Results There were 66 GW patients. The most affected body parts were extremities (60.6%, n = 40); 59% of cases (n = 39) were transferred to the hospitals with vehicles other than an ambulance. Furthermore, 77.3% of patients came to the hospitals directly from the site of event, and 22.7% of patients were referred from other medical centers. EMS action intervals from dispatchers to scene departure was not significantly different from established standards; however, arrival to hospital took longer than optimal standards. Additionally, time spent at emergency wards to stabilize vital signs was significantly less in patients who were transported by EMS ambulances (P = 0.01), but not with private ambulances (P = 0.47). However, ambulance pre-hospital care was not associated with a shorter hospital stay. Injury Severity was the only determinant of hospital stay duration (β = 0.36, P = 0.01) in multivariate analysis. Conclusions GW was more frequent in extremities and the most patients were directly transferred from the accident site. EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance. Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay. This showed that upgrade of ambulance equipment and training of private ambulance personnel may be needed. PMID:24350154

  6. Potential cardiac arrest – an observational study of pre-hospital medical response

    PubMed Central

    Zakariassen, Erik; Hunskaar, Steinar

    2016-01-01

    Objectives A previous study showed that Norwegian GPs on call attended around 40% of out-of-hospital medical emergencies. We wanted to investigate the alarms of prehospital medical resources and the doctors' responses in situations of potential cardiac arrests. Design and setting A three-month prospective data collection was undertaken from three emergency medical communication centres, covering a population of 816,000 residents. From all emergency medical events, a sub-group of patients who received resuscitation, or who were later pronounced dead at site, was selected for further analysis. Results 5,105 medical emergencies involving 5,180 patients were included, of which 193 met the inclusion criteria. The GP on call was alarmed in 59 %, and an anaesthesiologist in 43 % of the cases. When alarmed, a GP attended in 84 % and an anaesthesiologist in 87 % of the cases. Among the patients who died, the GP on call was alarmed most frequently. Conclusion Events involving patients in need of resuscitation are rare, but medical response in the form of the attendance of prehospital personnel is significant. Norwegian GPs have a higher call-out rate for patients in severe situations where resuscitation was an option of treatment, compared with other “red-response” situations. Key pointsThis study investigates alarms of and call-outs among GPs and anaesthesiologists on call, in the most acute clinical situations:Medical emergencies involving patients in need of resuscitation were rare.The health care contribution by pre-hospital personnel being called out was significant.Compared with other acute situations, the GP had a higher attendance rate to patients in life-threatening situations. PMID:27092724

  7. High Yield Research Opportunities in Geriatric Emergency Medicine: Prehospital Care, Delirium, Adverse Drug Events, and Falls

    PubMed Central

    Carpenter, Christopher R.; Shah, Manish N.; Hustey, Fredric M.; Heard, Kennon; Gerson, Lowell W.

    2011-01-01

    Emergency services constitute crucial and frequently used safety nets for older persons, an emergency visit by a senior very often indicates high vulnerability for functional decline and death, and interventions via the emergency system have significant opportunities to change the clinical course of older patients who require its services. However, the evidence base for widespread employment of emergency system-based interventions is lacking. In this article, we review the evidence and offer crucial research questions to capitalize on the opportunity to optimize health trajectories of older persons seeking emergency care in four areas: prehospital care, delirium, adverse drug events, and falls. PMID:21498881

  8. Communicative Management in Ambulatory Services: Prehospital Management Communication--Limits and Possibilities.

    PubMed

    Nordby, Halvor

    2015-01-01

    Poor management communication in healthcare services affects employees' motivation, commitment, and, in the final instance, organizational performance and the quality of patient care. In any area of health management, good communication is, therefore, key to successful management. This article discusses how managers of ambulance stations should secure communication with their paramedic crews. The first part uses ethical concepts to analyze communicative disagreement in interactive dialogue between managers and paramedics. The second part outlines basic communication principles that can serve as conceptual tools for avoiding misinterpretation in prehospital manager-employee interaction. PMID:26182699

  9. Communicative Management in Ambulatory Services: Prehospital Management Communication--Limits and Possibilities.

    PubMed

    Nordby, Halvor

    2015-01-01

    Poor management communication in healthcare services affects employees' motivation, commitment, and, in the final instance, organizational performance and the quality of patient care. In any area of health management, good communication is, therefore, key to successful management. This article discusses how managers of ambulance stations should secure communication with their paramedic crews. The first part uses ethical concepts to analyze communicative disagreement in interactive dialogue between managers and paramedics. The second part outlines basic communication principles that can serve as conceptual tools for avoiding misinterpretation in prehospital manager-employee interaction.

  10. Evolving prehospital, emergency department, and "inpatient" management models for geriatric emergencies.

    PubMed

    Carpenter, Christopher R; Platts-Mills, Timothy F

    2013-02-01

    Alternative management methods are essential to ensure high-quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols to support early condition-specific treatment of older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to address the influence of other factors on the patient's health. This article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care.

  11. Non-additive effects of delayed connexin hemichannel blockade and hypothermia after cerebral ischemia in near-term fetal sheep.

    PubMed

    Davidson, Joanne O; Rout, Alexandra L; Wassink, Guido; Yuill, Caroline A; Zhang, Frank G; Green, Colin R; Bennet, Laura; Gunn, Alistair J

    2015-12-01

    Hypothermia is partially neuroprotective after neonatal hypoxic-ischemic encephalopathy. Blockade of connexin hemichannels can improve recovery of brain activity and cell survival after ischemia in near-term fetal sheep. In this study, we investigated whether combining delayed hypothermia with connexin hemichannel blockade with intracerebroventricular infusion of a mimetic peptide can further improve outcomes after cerebral ischemia. Fetal sheep (0.85 gestation) received 30 minutes of cerebral ischemia followed by a 3-hour recovery period before treatment was started. Fetuses were randomized to one of the following treatment groups: normothermia (n=8), hypothermia for 3 days (n=8), connexin hemichannel blockade (50 μmol/L intracerebroventricular over 1 hour followed by 50 μmol/L over 24 hours, n=8) or hypothermia plus hemichannel blockade (n=7). After 7 days recovery, hypothermia was associated with reduced seizure burden, improved electroencephalographic (EEG) power, and a significant increase in neuronal and oligodendrocyte survival and reduced induction of Iba1-positive microglia. In contrast, although hemichannel blockade reduced seizure burden, there was no effect on EEG power or histology (P<0.05). There was no further improvement in outcomes with combined hypothermia plus hemichannel blockade. In conclusion, these data show that there is no additive neuroprotection with combined hypothermia and hemichannel blockade after cerebral ischemia in near-term fetal sheep.

  12. Non-additive effects of delayed connexin hemichannel blockade and hypothermia after cerebral ischemia in near-term fetal sheep.

    PubMed

    Davidson, Joanne O; Rout, Alexandra L; Wassink, Guido; Yuill, Caroline A; Zhang, Frank G; Green, Colin R; Bennet, Laura; Gunn, Alistair J

    2015-12-01

    Hypothermia is partially neuroprotective after neonatal hypoxic-ischemic encephalopathy. Blockade of connexin hemichannels can improve recovery of brain activity and cell survival after ischemia in near-term fetal sheep. In this study, we investigated whether combining delayed hypothermia with connexin hemichannel blockade with intracerebroventricular infusion of a mimetic peptide can further improve outcomes after cerebral ischemia. Fetal sheep (0.85 gestation) received 30 minutes of cerebral ischemia followed by a 3-hour recovery period before treatment was started. Fetuses were randomized to one of the following treatment groups: normothermia (n=8), hypothermia for 3 days (n=8), connexin hemichannel blockade (50 μmol/L intracerebroventricular over 1 hour followed by 50 μmol/L over 24 hours, n=8) or hypothermia plus hemichannel blockade (n=7). After 7 days recovery, hypothermia was associated with reduced seizure burden, improved electroencephalographic (EEG) power, and a significant increase in neuronal and oligodendrocyte survival and reduced induction of Iba1-positive microglia. In contrast, although hemichannel blockade reduced seizure burden, there was no effect on EEG power or histology (P<0.05). There was no further improvement in outcomes with combined hypothermia plus hemichannel blockade. In conclusion, these data show that there is no additive neuroprotection with combined hypothermia and hemichannel blockade after cerebral ischemia in near-term fetal sheep. PMID:26174327

  13. Asystolic Cardiac Arrest of Unknown Duration in Profound Hypothermia and Polysubstance Overdose: A Case Report of Complete Recovery

    PubMed Central

    Lubana, Sandeep Singh; Genin, Dennis Iilya; Singh, Navdeep; De La Cruz, Angel

    2015-01-01

    Patient: Male, 20 Final Diagnosis: Asystolic cardiac arrest in profound hypothermia and poly-substance overdose Symptoms: Cardiac arrest • cardiac arrhythmia Medication: — Clinical Procedure: Endotracheal intubation • hemodialysis Specialty: Critical Care Medicine Objective: Unusual clinical course Background: Opioid addiction and overdose is a serious problem worldwide. Fatal overdoses from opioids are responsible for numerous deaths and are increasing, especially if taken in combination with other psychoactive substances. Combined with environmental exposure, opioid overdose can cause profound hypothermia. Opioid abuse and other drugs of abuse impair thermoregulation, leading to severe hypothermia. Both drug overdose and severe hypothermia can cause cardiac arrest. Case Report: We report a case of 20-year-old man with history of polysubstance abuse presenting with severe hypothermia and asystole of unknown duration with return of spontaneous circulation (ROSC) achieved after 28 minutes of cardiopulmonary resuscitation (CPR). Urine toxicology was positive for cocaine, heroin, and benzodiazepine, along with positive blood alcohol level. The patient was rewarmed using non-invasive techniques. Hospital course was complicated by acute renal failure (ARF), severe rhabdomyolysis, severe hyperkalemia, ST-elevation myocardial infarction (STEMI), shock liver, coagulopathy, and aspiration pneumonia. Conclusions: Survival with full cardiovascular and neurologic recovery after a cardiac arrest caused by drug overdose in the setting of severe hypothermia is still possible, even if the cardiac arrest is of unknown or prolonged duration. Patients with severe hypothermia experiencing cardiac arrest/hemodynamic instability can be rewarmed using non-invasive methods and may not necessarily need invasive rewarming techniques. PMID:26054008

  14. Deep hypothermia-enhanced autophagy protects PC12 cells against oxygen glucose deprivation via a mitochondrial pathway.

    PubMed

    Tang, Dang; Wang, Cheng; Gao, Yongjun; Pu, Jun; Long, Jiang; Xu, Wei

    2016-10-01

    Deep hypothermia is known for its organ-preservation properties, which is introduced into surgical operations on the brain and heart, providing both safety in stopping circulation as well as an attractive bloodless operative field. However, the molecular mechanisms have not been clearly identified. This study was undertaken to determine the influence of deep hypothermia on neural apoptosis and the potential mechanism of these effects in PC12 cells following oxygen-glucose deprivation. Deep hypothermia (18°C) was given to PC12 cells while the model of oxygen-glucose deprivation (OGD) induction for 1h. After 24h of reperfusion, the results showed that deep hypothermia decreased the neural apoptosis, and significantly suppressed overexpression of Bax, CytC, Caspase 3, Caspase 9 and cleaved PARP-1, and inhibited the reduction of Bcl-2 expression. While deep hypothermia increased the LC3II/LC3I and Beclin 1, an autophagy marker, which can be inhibited by 3-methyladenine (3-MA), indicating that deep hypothermia-enhanced autophagy ameliorated apoptotic cell death in PC12 cells subjected to OGD. Based on these findings we propose that deep hypothermia protects against neural apoptosis after the induction of OGD by attenuating the mitochondrial apoptosis pathway, moreover, the mechanism of these antiapoptosis effects is related to the enhancement of autophagy, which autophagy might provide a means of neuroprotection against OGD.

  15. Medical instrument based on a heat pipe for local cavity hypothermia

    NASA Astrophysics Data System (ADS)

    Vasil'Ev, L. L.; Zhuraviyov, A. S.; Molodkin, F. F.; Khrolenok, V. V.; Zhdanov, V. L.; Vasil'Ev, V. L.; Adamov, S. I.; Tyurin, A. A.

    1996-05-01

    The design and results of tests of an instrument based on a heat pipe for local cavity hypothermia are presented. The instrument is a part of a device for noninvasive nonmedical treatment of inflammatory diseases of the organs of the small pelvis, pathologies of alimentary canal, etc.

  16. Comparison of three strategies for preventing hypothermia in critically injured casualties during aeromedical evacuation.

    PubMed

    Schmelz, Joseph O; Bridges, Elizabeth J; Wallace, Capt Marlene B; Sanders, Scott F; Shaw, Timothy; Kester, Nurani; Bauer, Steve; Sylvester, James C

    2007-03-01

    Critically injured patients are at risk for hypothermia. This study determined the efficacy of three hypothermia prevention strategies: the ChillBuster warming blanket, ChillBuster with a reflective blanket, and two wool blankets. A quasi-experimental design was used to compare changes in core temperature. Following resuscitation from hypovolemic shock, 20 swine were assigned to one of the three interventions, placed in an environmental chamber set to reproduce in-flight conditions onboard a military cargo aircraft (50 degrees F/airspeed 0.2 m/s), and monitored for 6 hours. A repeated measures analysis of variance and least-squared difference post hoc were performed. The ChillBuster/reflective blanket group was significantly warmer than the ChillBuster only group and the wool blanket group (p < 0.01). After 6 hours of cold exposure, the ChillBuster/reflective blanket group remained warm while the ChillBuster only and wool blanket groups developed mild hypothermia. Combined use of a warming blanket and reflective blanket was effective in preventing hypothermia over 6 hours and is feasible in a deployed military environment. PMID:17436780

  17. Human touch vs. axillary digital thermometry for detection of neonatal hypothermia at community level.

    PubMed

    Agarwal, Siddharth; Sethi, Vani; Pandey, Ravindra Mohan; Kondal, Dimple

    2008-06-01

    We examined the diagnostic accuracy of human touch (HT) method in assessing hypothermia against axillary digital thermometry (ADT) by a trained non-medical field investigator (who supervised activities of community health volunteers) in seven villages of Agra district, Uttar Pradesh, India. Body temperature of 148 newborns born between March and August 2005 was measured at four points in time for each enrolled newborn (within 48 h and on days 7, 30 and 60) by the field investigator under the axilla using a digital thermometer and by HT method using standard methodology. Total observations were 533. Hypothermia assessed by HT was in agreement with that assessed by ADT (<36.5 degrees C) in 498 observations. Hypothermia assessed by HT showed a high diagnostic accuracy when compared against ADT (kappa 0.65-0.81; sensitivity 74%; specificity 96.7%; positive predictive value 22; negative predictive value 0.26). HT is a simple, quick, inexpensive and programmatically important method. However, being a subjective assessment, its reliability depends on the investigator being adequately trained and competent in making consistently accurate assessments. There is also a need to assess whether with training and supervision even the less literate mothers, traditional birth attendants and community health volunteers can accurately assess mild and moderate hypothermia before promoting HT for early identification of neonatal risk in community-based programs.

  18. Thermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia.

    PubMed

    Torossian, Alexander

    2008-12-01

    Incidence of inadvertent perioperative hypothermia is still high, and thus thermoregulatory standards are warranted. This review summarizes current evidence of thermal management during anaesthesia, referring to recognized clinical queries (temperature measurement, definition of hypothermia, risk factors, warming methods, implementation strategies). Body temperature is a vital sign, and 37 degrees C is the mean core temperature of a healthy human. Systematic review shows that for non-invasive temperature monitoring the oral route is the most reliable; infrared ear temperature measurement is inaccurate. Intraoperatively, acceptable semi-invasive temperature monitoring sites are the nasopharynx, oesophagus and urinary bladder. Clinically relevant hypothermia starts at 36 degrees C with regard to major adverse outcomes (increased infectious complications, morbid cardiac events, coagulation disorders, prolonged length of hospital stay, and increased costs). Skin surface warming for 20 min immediately before anaesthesia (pre-warming) minimizes initial redistribution hypothermia. Intraoperatively, active warming should be applied when anaesthesia time is > 60 min. Effective methods of active warming are forced-air warming or conductive warming, provided that enough skin surface is available. Infusion fluid warming, increasing the operating room temperature, and warming of irrigation fluids are adjunctive therapies. The patient's body temperature should be above 36 degrees C before induction of anaesthesia, and should be measured continuously throughout surgery. Active warming should be applied intraoperatively. Postoperative patient temperature and outcomes should be evaluated. PMID:19137809

  19. Shapiro's syndrome: Defining the clinical spectrum of the spontaneous paroxysmal hypothermia syndrome.

    PubMed

    Tambasco, Nicola; Belcastro, Vincenzo; Prontera, Paolo; Nigro, Pasquale; Donti, Emilio; Rossi, Aroldo; Calabresi, Paolo

    2014-07-01

    Shapiro Syndrome (SS) is a rare condition of spontaneous periodic hypothermia, corpus callosum agenesis (ACC) and hyperhidrosis which can occur at any age. The variant form refers to the phenotypic SS without ACC. We reported the case of SS variant on a 4-year-old boy who presented from his first year frequent episodes of hypothermia lasting 2-3 h with core rectal temperatures <35 °C. In order to understand the characteristics of this rare syndrome we searched all the cases present in literature. Fifty-two cases of SS were found in literature. Among all clinical signs, paroxysmal hypothermia seems to be the hallmark of both typical and variant SS. ACC is reported only in 40% of cases of SS. Hyperhidrosis, another hallmark of SS, was present in only 42.3% of the cases and mainly in adult onset. The presence of SS in siblings of different genders suggests an autosomal recessive inheritance model, however a gonadic mosaicism responsible for an autosomal de novo mutation cannot be ruled out. From our review of well documented cases of SS, we conclude that only the episodic and spontaneous paroxysmal hypothermia should be considered the defining hallmark of typical and variant SS. This can be important to define the clinical manifestation of SS improving the early diagnosis. PMID:24594427

  20. Comparison of three strategies for preventing hypothermia in critically injured casualties during aeromedical evacuation.

    PubMed

    Schmelz, Joseph O; Bridges, Elizabeth J; Wallace, Capt Marlene B; Sanders, Scott F; Shaw, Timothy; Kester, Nurani; Bauer, Steve; Sylvester, James C

    2007-03-01

    Critically injured patients are at risk for hypothermia. This study determined the efficacy of three hypothermia prevention strategies: the ChillBuster warming blanket, ChillBuster with a reflective blanket, and two wool blankets. A quasi-experimental design was used to compare changes in core temperature. Following resuscitation from hypovolemic shock, 20 swine were assigned to one of the three interventions, placed in an environmental chamber set to reproduce in-flight conditions onboard a military cargo aircraft (50 degrees F/airspeed 0.2 m/s), and monitored for 6 hours. A repeated measures analysis of variance and least-squared difference post hoc were performed. The ChillBuster/reflective blanket group was significantly warmer than the ChillBuster only group and the wool blanket group (p < 0.01). After 6 hours of cold exposure, the ChillBuster/reflective blanket group remained warm while the ChillBuster only and wool blanket groups developed mild hypothermia. Combined use of a warming blanket and reflective blanket was effective in preventing hypothermia over 6 hours and is feasible in a deployed military environment.

  1. Shallow hypothermia depends on the level of fatty acid unsaturation in adipose and liver tissues in a tropical heterothermic primate.

    PubMed

    Vuarin, Pauline; Henry, Pierre-Yves; Guesnet, Philippe; Alessandri, Jean-Marc; Aujard, Fabienne; Perret, Martine; Pifferi, Fabien

    2014-07-01

    Optimal levels of unsaturated fatty acids have positive impacts on the use of prolonged bouts of hypothermia in mammalian hibernators, which generally have to face low winter ambient temperatures. Unsaturated fatty acids can maintain the fluidity of fat and membrane phospholipids at low body temperatures. However, less attention has been paid to their role in the regulation of shallow hypothermia, and in tropical species, which may be challenged more by seasonal energetic and/or water shortages than by low temperatures. The present study assessed the relationship between the fatty acids content of white adipose and liver tissues and the expression of shallow hypothermia in a tropical heterothermic primate, the gray mouse lemur (Microcebus murinus). The adipose tissue is the main tissue for fat storage and the liver is involved in lipid metabolism, so both tissues were expected to influence hypothermia dependence on fatty acids. As mouse lemurs largely avoid deep hypothermia (i.e. torpor) use under standard captive conditions, the expression of hypothermia was triggered by food-restricting experimental animals. Hypothermia depth increased with time, with a stronger increase for individuals that exhibited higher contents of unsaturated fatty acids suggesting that they were more flexible in their use of hypothermia. However these same animals delayed the use of long hypothermia bouts relative to individuals with a higher level of saturated fatty acids. This study evidences for the first time that body fatty acids unsaturation levels influence the regulation of body temperature not only in cold-exposed hibernators but also in tropical, facultative heterotherms.

  2. Optimal values for oxygen transport during hypothermia in sepsis and ARDS.

    PubMed

    Pernerstorfer, T; Krafft, P; Fitzgerald, R; Fridrich, P; Koc, D; Hammerle, A F; Steltzer, H

    1995-01-01

    Mild hypothermia (33 degrees C to 35.5 degrees C) is reported to improve oxygenation and survival in patients with lung failure (1). Although hypermetabolism may account for about 50% of the ventilatory demand in ARDS patients, the concept of reducing oxygen consumption (VO2) by lowering metabolic rate, has only recently gained attention (2). Our study was aimed to test whether mild hypothermia established by continuous veno-venous haemofiltration (CVVHF), could optimize values for oxygen kinetics in ARDS patients. Overall, we recruited 27 patients with ARDS and sepsis. Prior initiation of CVVHF patients had to meet the following criteria: a) Murray score > 2.5, and hypoxaemia with PaO2/FIO2 < 200, b) hyperthermia of > 38 degrees C, c) cardiovascular instability requiring inotropic support. Evaluation of cardio-respiratory data was performed within four different phases (I = before, II + III during and IV = after CVVHF) every 6 hours. Core temperature as derived from the thermistor of pulmonary artery catheter was aimed to be between 35.0 degrees C and 36.5 degrees C. Optimal values for oxygen delivery (DO2) (> 550 mL/min/m2) and VO2 (> 160 mL/min/m2) were defined according to Shoemaker and achieved by fluid loading, transfusion and inotropic support (3). Septic shock occurred in 10 of 14 nonsurvivors (nons) and 2 of 13 survivors (surv). Mean values for DO2 and VO2 were calculated at different body temperature ranges. While at 37 degrees C DO2 was identical between surv and nons, (663 +/- 128 versus 666 +/- 127 means +/- SD) moderate hypothermia led to a small decrease of DO2 in surv and a significant decrease in nons (632 +/- 134 versus 605 +/- 128 mL/min/m2) at 35 degrees C. Concerning VO2 during hypothermia, there was a significant drop in nonsurvivors while in survivors the decrease was less pronounced. We could demonstrate a decrease in DO2 and VO2 during mild hypothermia during CVVHF. However, decreases in nonsurvivors were more pronounced than in survivors

  3. Mild hypothermia markedly reduces ischemia related coronary t-PA release.

    PubMed

    van der Pals, Jesper; Götberg, Matthias; Olivecrona, Göran K; Brogren, Helen; Jern, Sverker; Erlinge, David

    2010-04-01

    In experimentally induced myocardial ischemia, mild hypothermia (33-35 degrees C) has a robust cardioprotective effect. Tissue plasminogen activator (t-PA) is a profibrinolytic enzyme that is released from the vascular endothelial cells in response to ischemia and other injurious stimuli. t-PA has also been found to have proinflammatory properties that could contribute to reperfusion injury. We postulated that hypothermia could attenuate t-PA release in the setting of myocardial ischemia. Sixteen 25-30 kg pigs were anesthetized and a temperature of 37 degrees C was established using an intravascular cooling/warming catheter. The pigs were then randomized to hypothermia (34 degrees C) or control (37 degrees C). A doppler flow wire was placed distal to a percutaneous coronary intervention balloon positioned immediately distal to the first diagonal branch of the left anterior descending artery (LAD). The LAD was then occluded for 10 min in all pigs. Coronary blood flow and t-PA was measured before, during and after ischemia/reperfusion. t-PA was measured in peripheral arterial blood and locally in the venous blood from the coronary sinus. Net t-PA release over the coronary bed was calculated by subtraction of arterial values from coronary sinus values. An estimate of differences in total t-PA release was calculated by multiplying net t-PA release with the relative increase in flow compared to baseline, measured in relative units consisting of ((ng/ml - ng/ml) x (cm/s/cm/s)). There was no observed difference in t-PA levels in peripheral arterial samples. As shown previously, net t-PA release increased during reperfusion. Hypothermia significantly inhibited the increase in t-PA release during reperfusion (peak value 9.44 +/- 4.34 ng/ml vs. 0.79 +/- 0.45 ng/ml, P = 0.02). The effect was even more prominent when an estimation of total t-PA release was performed with mean peak value in the control group 26-fold higher than in the hypothermia group (69.74 +/- 33.86 units vs

  4. Control of rapid hypothermia induction by total liquid ventilation: preliminary results.

    PubMed

    Nadeau, Mathieu; Micheau, Philippe; Robert, Raymond; Avoine, Olivier; Tissier, Renaud; Germim, Pamela Samanta; Walti, Hervé

    2013-01-01

    Mild therapeutic hypothermia (MTH) consists in cooling the body temperature of a patient to between 32 and 34 °C. This technique helps to preserve tissues and neurological functions in multi-organ failure by preventing ischemic injury. Total liquid ventilation (TLV) ensures gas exchange in the lungs with a liquid, typically perfluorocarbon (PFC). A liquid ventilator is responsible for ensuring cyclic renewal of tidal volume of oxygenated and temperature-controlled PFC. Hence, TLV using the lung as a heat exchanger and PFC as a heat carrier allows ultra fast cooling of the whole body which can help improve outcome after ischemic injuries. The present study was aimed to evaluate the control performance and safety of automated ultrarapid MTH induction by TLV. Experimentation was conducted using the Inolivent-5.0 liquid ventilator equipped with a PFC treatment unit that allows PFC cooling and heating from the flow of energy carrier water inside a double wall installed on an oxygenator. A water circulating bath is used to manage water temperature. A feedback controller was developed to modulate inspired PFC temperature and control body temperature. Such a controller is important since, with MTH induction, heart temperature should not reach 28 °C because of a high risk of fibrillation. The in vivo experimental protocol was conducted on a male newborn lamb of 4.7 kg which, after anesthetization, was submitted to conventional gas ventilation and instrumented with temperature sensors at the femoral artery, oesophagus, right ear drum and rectum. After stabilization, TLV was initiated with fast automated MTH induction to 33.5 °C until stabilization of all temperatures. MTH could be reached safely in 3 minutes at the femoral artery, in 3.6 minutes at the esophagus, in 7.7 minutes at the eardrum and in 15 minutes at the rectum. All temperatures were stable at 33.5 ± 0.5 °C within 15 minutes. The present results reveal that ultra-fast MTH induction by TLV with Inolivent-5

  5. Transient hypothermia in HIV-1 with insulin-like growth factor-1 deficiency and severe protein calorie malnutrition

    PubMed Central

    McNeal, Tresa

    2015-01-01

    Hypothermia is a multifactorial process that results from decreased heat production or increased heat loss, with the former due to, but not limited to, endocrine dysfunction, malnutrition, and central nervous system pathologies. We report an HIV-1 patient with transient hypothermia secondary to severe protein calorie malnutrition and elevated HIV viral load. In this patient, it is hypothesized that the etiology of the hypothermia was multifactorial due to severe protein calorie malnutrition, evidenced by decreased insulin-like growth factor-1 levels, severe hypothyroidism, and an elevated HIV viral load, since the patient began to improve with the initiation of highly active antiretroviral therapy, improved nutrition, and continuation of thyroid supplementation. PMID:25552791

  6. Molecular pathology of pulmonary surfactants and cytokines in drowning compared with other asphyxiation and fatal hypothermia.

    PubMed

    Miyazato, Takako; Ishikawa, Takaki; Michiue, Tomomi; Maeda, Hitoshi

    2012-07-01

    Drowning involves complex fatal factors, including asphyxiation and electrolyte/osmotic disturbances, as well as hypothermia in cold water. The present study investigated the molecular pathology of pulmonary injury due to drowning, using lung specimens from forensic autopsy cases of drowning (n = 21), acute mechanical asphyxia due to neck compression and smothering (n = 24), and hypothermia (cold exposure, n = 11), as well as those of injury (n = 23), intoxication (n = 13), fire fatality (n = 18), and acute cardiac death (n = 9) for comparison. TaqMan real-time reverse transcription polymerase chain reaction was used to quantify messenger RNA (mRNA) expressions of pulmonary surfactant-associated proteins A and D (SP-A and SP-D), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-10. SP-A and SP-D mRNA levels were lower for drowning, mechanical asphyxiation, fire fatality, and acute cardiac deaths than for hypothermia and injury. TNF-α, IL-1β, and IL-10 mRNA levels were higher for drowning or for drowning and injury than for other groups; there was no significant difference between fire fatality, involving airway injury due to inhalation of hot/irritant gases, and other control groups. These observations suggest characteristic molecular biological patterns of pulmonary injury involving suppression of pulmonary surfactants and activation of early-phase mediators of inflammation in drowning, with high mRNA expression levels of pulmonary surfactants in fatal hypothermia; however, there was no significant difference among these markers in immunohistochemical detection, except for SP-A. These mRNA expressions can be used as markers of pulmonary injury to assist in investigations of the pathophysiology of drowning and fatal hypothermia in combination with other biochemical and biological markers.

  7. Neuroprotective effects of hypothermia on synaptic actin cytoskeletal changes induced by perinatal asphyxia.

    PubMed

    Muñiz, Javier; Romero, Juan; Holubiec, Mariana; Barreto, George; González, Janneth; Saint-Martin, Madeleine; Blanco, Eduardo; Carlos Cavicchia, Juan; Castilla, Rocío; Capani, Francisco

    2014-05-14

    Cerebral hypoxia-ischemia damages synaptic proteins, resulting in cytoskeletal alterations, protein aggregation and neuronal death. In the previous works, we have shown neuronal and synaptic changes in rat neostriatum subjected to hypoxia that leads to ubi-protein accumulation. Recently, we also showed that, changes in F-actin organization could be related to early alterations induced by hypoxia in the Central Nervous System. However, little is known about effective treatment to diminish the damage. The main aim of this work is to study the effects of birth hypothermia on the actin cytoskeleton of neostriatal post-synaptic densities (PSD) in 60 days olds rats by immunohistochemistry, photooxidation and western blot. We used 2 different protocols of hypothermia: (a) intrahypoxic hypothermia at 15°C and (b) post-hypoxia hypothermia at 32°C. Consistent with previous data at 30 days, staining with phalloidin-Alexa(488) followed by confocal microscopy analysis showed an increase of F-actin fluorescent staining in the neostriatum of hypoxic animals. Correlative photooxidation electron microscopy confirmed these observations showing an increment in the number of mushroom-shaped F-actin staining spines in neostriatal excitatory synapses in rats subjected to hypoxia. In addition, western blot revealed β-actin increase in PSDs in hypoxic animals. The optic relative density measurement showed a significant difference between controls and hypoxic animals. When hypoxia was induced under hypothermic conditions, the changes observed in actin cytoskeleton were blocked. Post-hypoxic hypothermia showed similar answer but actin cytoskeleton modifications were not totally reverted as we observed at 15°C. These data suggest that the decrease of the body temperature decreases the actin modifications in dendritic spines preventing the neuronal death.

  8. Cardiovascular effects of epinephrine during rewarming from hypothermia in an intact animal model.

    PubMed

    Kondratiev, T V; Myhre, E S P; Simonsen, O; Nymark, T-B; Tveita, T

    2006-02-01

    Rewarming from accidental hypothermia is often complicated by "rewarming shock," characterized by low cardiac output (CO) and a sudden fall in peripheral arterial pressure. In this study, we tested whether epinephrine (Epi) is able to prevent rewarming shock when given intravenously during rewarming from experimental hypothermia in doses tested to elevate CO and induce vasodilation, or lack of vasodilation, during normothermia. A rat model designed for circulatory studies during experimental hypothermia and rewarming was used. A total of six groups of animals were used: normothermic groups 1, 2, and 3 for dose-finding studies, and hypothermic groups 4, 5, and 6. At 20 and 24 degrees C during rewarming, group 4 (low-dose Epi) and group 5 (high-dose Epi) received bolus injections of 0.1 and 1.0 microg Epi, respectively. At 28 degrees C, Epi infusion was started in groups 4 and 5 with 0.125 and 1.25 microg/min, respectively. Group 6 served as saline control. After rewarming, both CO and stroke volume were restored in group 4, in contrast to groups 5 and 6, in which both CO and stroke volume remained significantly reduced (30%). Total peripheral resistance was significantly higher in group 5 during rewarming from 24 to 34 degrees C, compared with groups 4 and 6. This study shows that, in contrast to normothermic conditions, Epi infused during hypothermia