Targeted temperature management

453:, the core body temperature is monitored and feedback to the machine allows changes in the water blanket to achieve the desired set temperature. In the past some of the models of cooling machines have produced an overshoot in the target temperature and cooled people to levels below 32 °C (90 °F), resulting in increased adverse events. They have also rewarmed patients at too fast a rate, leading to spikes in intracranial pressure. Some of the new models have more software that attempt to prevent this overshoot by utilizing warmer water when the target temperature is close and preventing any overshoot. Some of the new machines now also have 3 rates of cooling and warming; a rewarming rate with one of these machines allows a patient to be rewarmed at a very slow rate of just 0.17 °C (0.31 °F) an hour in the "automatic mode", allowing rewarming from 33 °C (91 °F) to 37 °C (99 °F) over 24 hours. 507:(AHA) and the International Liaison Committee on Resuscitation (ILCOR) endorsed the use of targeted temperature management following cardiac arrest. Currently, a growing percentage of hospitals around the world incorporate the AHA/ILCOR guidelines and include hypothermic therapies in their standard package of care for patients with cardiac arrest. Some researchers go so far as to contend that hypothermia represents a better neuroprotectant following a blockage of blood to the brain than any known drug. Over this same period a particularly successful research effort showed that hypothermia is a highly effective treatment when applied to newborn infants following 301:, a molecule used by cells to store energy, and cells need ATP to regulate intracellular ion levels. ATP is used to fuel both the importation of ions necessary for cellular function and the removal of ions that are harmful to cellular function. Without oxygen, cells cannot manufacture the necessary ATP to regulate ion levels and thus cannot prevent the intracellular environment from approaching the ion concentration of the outside environment. It is not oxygen deprivation itself that precipitates cell death, but rather without oxygen the cell can not make the ATP it needs to regulate ion concentrations and maintain homeostasis. 3033: 470:. In the continuously cooled iteration, coolant is cooled with the aid of a compressor and pumped through the cooling cap. Circulation is regulated by means of valves and temperature sensors in the cap. If the temperature deviates or if other errors are detected, an alarm system is activated. The frozen iteration involves continuous application of caps filled with Crylon gel cooled to −30 °C (−22 °F) to the scalp before, during and after intravenous chemotherapy. As the caps warm on the head, multiple cooled caps must be kept on hand and applied every 20 to 30 minutes. 392:

2 °C (2.7 to 3.6 °F) per hour. Through the use of the control unit, catheters can bring body temperature to within 0.1 °C (0.18 °F) of the target level. Furthermore, catheters can raise temperature at a steady rate, which helps to avoid harmful rises in intracranial pressure. A number of studies have demonstrated that targeted temperature management via catheter is safe and effective.

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blankets causing significant burns to the skin of person. Other problems with external cooling include overshoot of temperature (20% of people will have overshoot), slower induction time versus internal cooling, increased compensatory response, decreased patient access, and discontinuation of cooling for invasive procedures such as the cardiac catheterization.

399:(DVT). Infection caused by cooling catheters is particularly harmful, as resuscitated people are highly vulnerable to the complications associated with infections. Bleeding represents a significant danger, due to a decreased clotting threshold caused by hypothermia. The risk of deep vein thrombosis may be the most pressing medical complication. 247:

heart is stopped and an external heart-lung pump maintains circulation to the patient's body. The heart is cooled further and is maintained at a temperature below 15 °C (59 °F) for the duration of the surgery. This very cold temperature helps the heart muscle to tolerate its lack of blood supply during the surgery.

309:

dips in temperature strengthen the cellular membrane, helping to minimize any disruption to the cellular environment. It is by moderating the disruption of homeostasis caused by a blockage of blood flow that many now postulate, results in hypothermia's ability to minimize the trauma resultant from ischemic injuries.

238:. A 2013 Cochrane review found that it is useful in full term babies with encephalopathy. Whole body or selective head cooling to 33–34 °C (91–93 °F), begun within six hours of birth and continued for 72 hours, reduces mortality and reduces cerebral palsy and neurological deficits in survivors. 427:

Transnasal evaporative cooling is a method of inducing the hypothermia process and provides a means of continuous cooling of a person throughout the early stages of targeted temperature management and during movement throughout the hospital environment. This technique uses two cannulae, inserted into

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Cooling catheters are inserted into a femoral vein. Cooled saline solution is circulated through either a metal coated tube or a balloon in the catheter. The saline cools the person's whole body by lowering the temperature of a person's blood. Catheters reduce temperature at rates ranging from 1.5 to

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There are a number of methods through which hypothermia is induced. These include: cooling catheters, cooling blankets, and application of ice applied around the body among others. As of 2013 it is unclear if one method is any better than the others. While cool intravenous fluid may be given to start

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production. Since hypothermia reduces both intracranial pressure and free radical production, this might be yet another mechanism of action for hypothermia's therapeutic effect. Overt activation of N-methyl-D-aspartate (NMDA) receptors following brain injuries can lead to calcium entry which triggers

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stability during periods of oxygen deprivation. For this reason, a drop in body temperature helps prevent an influx of unwanted ions during an ischemic insult. By making the cell membrane more impermeable, hypothermia helps prevent the cascade of reactions set off by oxygen deprivation. Even moderate

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Animal studies have shown the benefit of targeted temperature management in traumatic central nervous system (CNS) injuries. Clinical trials have shown mixed results with regards to the optimal temperature and delay of cooling. Achieving therapeutic temperatures of 33 °C (91 °F) is thought

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resulting from a drop in body temperature. For every one degree Celsius drop in body temperature, cellular metabolism slows by 5–7%. Accordingly, most early hypotheses suggested that hypothermia reduces the harmful effects of ischemia by decreasing the body's need for oxygen. The initial emphasis on

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Prior to the induction of targeted temperature management, pharmacological agents to control shivering must be administered. When body temperature drops below a certain threshold—typically around 36 °C (97 °F)—people may begin to shiver. It appears that regardless of the technique used to

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Core body temperature must be measured (either via the esophagus, rectum, bladder in those who are producing urine, or within the pulmonary artery) to guide cooling. A temperature below 30 °C (86 °F) should be avoided, as adverse events increase significantly. The person should be kept at

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recorded that officers who were kept closer to the fire survived less often than the minimally pampered infantrymen. In modern times, the first medical article concerning hypothermia was published in 1945. This study focused on the effects of hypothermia on patients with severe head injury. In the

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There are a number of non-invasive head cooling caps and helmets designed to target cooling at the brain. A hypothermia cap is typically made of a synthetic material such as neoprene, silicone, or polyurethane and filled with a cooling agent such as ice or gel which is either cooled to a very cold

444:

Water blankets possess several undesirable qualities. They are susceptible to leaking, which may represent an electrical hazard since they are operated in close proximity to electrically powered medical equipment. The Food and Drug Administration also has reported several cases of external cooling

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when the blood supply is restored to a tissue after a period of ischemia. Various inflammatory immune responses occur during reperfusion. These inflammatory responses cause increased intracranial pressure, which leads to cell injury and in some situations, cell death. Hypothermia has been shown to

246:

Targeted temperature management is used during open-heart surgery because it decreases the metabolic needs of the brain, heart, and other organs, reducing the risk of damage to them. The patient is given medication to prevent shivering. The body is then cooled to 25–32 °C (77–90 °F). The

204:

However, more recent research suggests that there is no benefit to cooling to 33 °C (91 °F) when compared with less aggressive cooling only to a near-normal temperature of 36 °C (97 °F); it appears cooling is effective because it prevents fever, a common complication seen after

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This period also saw sporadic investigation of more mild forms of hypothermia, with mild hypothermia being defined as a body temperature of 32–34 °C (90–93 °F). In the 1950s, Doctor Rosomoff demonstrated in dogs the positive effects of mild hypothermia after brain ischemia and traumatic

2490:

Nolan, J.P.; Morley, PT; Vanden Hoek, TL; Hickey, RW; Kloeck, WG; Billi, J; Böttiger, BW; Morley, PT; Nolan, JP; Okada, K; Reyes, C; Shuster, M; Steen, PA; Weil, MH; Wenzel, V; Hickey, RW; Carli, P; Vanden Hoek, TL; Atkins, D; International Liaison Committee on Resuscitation (2003). "Therapeutic

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of the venous system and the right side of the heart. However, most cooling catheters are triple lumen catheters, and the majority of people post-arrest will require central venous access. Unlike non-invasive methods which can be administered by nurses, the insertion of cooling catheters must be

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The method is compact enough to be used at the point of cardiac arrest, during ambulance transport, or within the hospital proper. It is intended to reduce rapidly the person's temperature to below 34 °C (93 °F) while targeting the brain as the first area of cooling. Research into the

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but not the overall risk of infection. Another review found a trend towards increased bleeding but no increase in severe bleeding. Hypothermia induces a "cold diuresis" which can lead to electrolyte abnormalities – specifically hypokalemia, hypomagnesaemia, and hypophosphatemia, as well as

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With these technologies, cold water circulates through a blanket, or torso wraparound vest and leg wraps. To lower temperature with optimal speed, 70% of a person's surface area should be covered with water blankets. The treatment represents the most well studied means of controlling body

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There is currently no evidence supporting targeted temperature management use in humans for stroke and clinical trials have not been completed. Most of the data concerning hypothermia's effectiveness in treating stroke is limited to animal studies. These studies have focused primarily on

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brain injury. In the 1980s further animal studies indicated the ability of mild hypothermia to act as a general neuroprotectant following a blockage of blood flow to the brain. This animal data was supported by two landmark human studies that were published simultaneously in 2002 by the

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Van Den Hurk, Corina J.; Peerbooms, Mijke; Van De Poll-Franse, Lonneke V.; Nortier, Johan W.; Coebergh, Jan Willem W.; Breed, Wim P. (2012). "Scalp cooling for hair preservation and associated characteristics in 1411 chemotherapy patients – Results of the Dutch Scalp Cooling Registry".

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Castren, M.; Nordberg, P.; Svensson, L.; Taccone, F.; Vincent, J.-L.; Desruelles, D.; Eichwede, F.; Mols, P.; Schwab, T.; Vergnion, M.; Storm, C.; Pesenti, A.; Pachl, J.; Guérisse, F.; Elste, T.; Roessler, M.; Fritz, H.; Durnez, P.; Busch, H.-J.; Inderbitzen, B.; Barbut, D. (2010).

2128:

Haugk, Moritz; Sterz, Fritz; Grassberger, Martin; Uray, Thomas; Kliegel, Andreas; Janata, Andreas; Richling, Nina; Herkner, Harald; Laggner, Anton N. (2007). "Feasibility and efficacy of a new non-invasive surface cooling device in post-resuscitation intensive care medicine".

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guidelines support the use of cooling following resuscitation from cardiac arrest. These recommendations were largely based on two trials from 2002 which showed improved survival and brain function when cooled to 32–34 °C (90–93 °F) after cardiac arrest.

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Vargas, M; Servillo, G; Sutherasan, Y; Rodríguez-González, R; Brunetti, I; Pelosi, P (June 2015). "Effects of in-hospital low targeted temperature after out of hospital cardiac arrest: A systematic review with meta-analysis of randomized clinical trials".

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cellular metabolism explains why the early studies almost exclusively focused on the application of deep hypothermia, as these researchers believed that the therapeutic effects of hypothermia correlated directly with the extent of temperature decline.

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Targeted temperature management should be started as soon as possible. The goal temperature should be reached before 8 hours. Targeted temperature management remains partially effective even when initiated as long as 6 hours after collapse.

2206:

Busch, H.-J.; Eichwede, F.; Födisch, M.; Taccone, F.S.; Wöbker, G.; Schwab, T.; Hopf, H.-B.; Tonner, P.; Hachimi-Idrissi, S.; Martens, P.; Fritz, H.; Bode, Ch.; Vincent, J.-L.; Inderbitzen, B.; Barbut, D.; Sterz, F.; Janata, A. (2010).

495:, defined as a body temperature of 20–25 °C (68–77 °F). Such an extreme drop in body temperature brings with it a whole host of side effects, which made the use of deep hypothermia impractical in most clinical situations. 428:

a person's nasal cavity, to deliver a spray of coolant mist that evaporates directly underneath the brain and base of the skull. As blood passes through the cooling area, it reduces the temperature throughout the rest of the body.

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If therapy with water blankets is given along with two litres of cold intravenous saline, people can be cooled to 33 °C (91 °F) in 65 minutes. Most machines now come with core temperature probes. When inserted into the

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temperature, −25 to −30 °C (−13 to −22 °F), before application or continuously cooled by an auxiliary control unit. Their most notable uses are in preventing or reducing alopecia in chemotherapy, and for preventing

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Hinz, Jos??; Rosmus, Martin; Popov, Aron; Moerer, Onnen; Frerichs, Inez; Quintel, Michael (2007). "Effectiveness of an Intravascular Cooling Method Compared with a Conventional Cooling Technique in Neurologic Patients".

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Hadziselimovic, Edina; Thomsen, Jakob Hartvig; Kjaergaard, Jesper; Køber, Lars; Graff, Claus; Pehrson, Steen; Nielsen, Niklas; Erlinge, David; Frydland, Martin; Wiberg, Sebastian; Hassager, Christian (July 2018).

1325:

Peberdy, MA; Callaway, CW; Neumar, RW; Geocadin, RG; Zimmerman, JL; Donnino, M; Gabrielli, A; Silvers, SM; Zaritsky, AL; Merchant, R; Vanden Hoek, TL; Kronick, SL; American Heart, Association (2 November 2010).

663:

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Xiao, G.; Guo, Q.; Shu, M.; Xie, X.; Deng, J.; Zhu, Y.; Wan, C. (2012). "Safety profile and outcome of mild therapeutic hypothermia in patients following cardiac arrest: Systematic review and meta-analysis".

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device has shown cooling rates of 2.6 °C (4.7 °F) per hour in the brain (measured through infrared tympanic measurement) and 1.6 °C (2.9 °F) per hour for core body temperature reduction.

511:. Meta-analysis of a number of large randomised controlled trials showed that hypothermia for 72 hours started within 6 hours of birth significantly increased the chance of survival without brain damage. 296:

interrupts the apoptotic pathway. In general, cell death is not directly caused by oxygen deprivation, but occurs indirectly as a result of the cascade of subsequent events. Cells need oxygen to create

402:

Deep vein thrombosis can be characterized as a medical event whereby a blood clot forms in a deep vein, usually the femoral vein. This condition may become potentially fatal if the clot travels to the

122:

in a person for a specific duration of time in an effort to improve health outcomes during recovery after a period of stopped blood flow to the brain. This is done in an attempt to reduce the risk of

503:. Both studies, one occurring in Europe and the other in Australia, demonstrated the positive effects of mild hypothermia applied following cardiac arrest. Responding to this research, in 2003 the 491:

1950s, hypothermia received its first medical application, being used in intracerebral aneurysm surgery to create a bloodless field. Most of the early research focused on the applications of

1410:

Stockmann, H; Krannich, A; Schroeder, T; Storm, C (November 2014). "Therapeutic temperature management after cardiac arrest and the risk of bleeding: Systematic review and meta-analysis".

410:. Another potential problem with cooling catheters is the potential to block access to the femoral vein, which is a site normally used for a variety of other medical procedures, including 219:

summarized available evidence on the topic and found that targeted temperature management around 33 °C may increase the chance to prevent brain damage after cardiac arrest by 40%.

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induce hypothermia, people begin to shiver when temperature drops below this threshold. Drugs commonly used to prevent and treat shivering in targeted temperature management include

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Diringer, Michael N.; Neurocritical Care Fever Reduction Trial Group (2004). "Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system".

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the goal temperature plus or minus half a degree Celsius for 24 hours. Rewarming should be done slowly with suggested speeds of 0.1 to 0.5 °C (0.18 to 0.90 °F) per hour.

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TTM has been studied in several use scenarios where it has not usually been found to be helpful, or is still under investigation, despite theoretical grounds for its usefulness.

2828:

Lundbye JB, Rai M, Kluger J (2012). "Therapeutic hypothermia is associated with improved neurologic outcome and survival in cardiac arrest survivors of non-shockable rhythms".

1546:

Polderman, Kees H. (2004). "Application of therapeutic hypothermia in the ICU: Opportunities and pitfalls of a promising treatment modality. Part 1: Indications and evidence".

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performed by a physician fully trained and familiar with the procedure. The time delay between identifying a person who might benefit from the procedure and the arrival of an

1231:

Gocoł, Radosław; Hudziak, Damian; Bis, Jarosław; Mendrala, Konrad; Morkisz, Łukasz; Podsiadło, Paweł; Kosiński, Sylweriusz; Piątek, Jacek; Darocha, Tomasz (January 2021).

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Patel, JK; Parikh, PB (7 April 2016). "Association between therapeutic hypothermia and long-term quality of life in survivors of cardiac arrest: A systematic review".

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that might damage the brain. Body temperature may be lowered by many means, including cooling blankets, cooling helmets, cooling catheters, ice packs and ice water

751: 2292:

Clumpner, M; Mobley, J (2008). "Raising the dead. Prehospital hypothermia for cardiac arrest victims may improve neurological outcome and survival to discharge".

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Geurts, Marjolein; MacLeod, Malcolm R.; Kollmar, Rainer; Kremer, Philip H. C.; Van Der Worp, H. Bart (2013). "Therapeutic Hypothermia and the Risk of Infection".

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Targeted temperature management is thought to prevent brain injury by several methods, including decreasing the brain's oxygen demand, reducing the production of

2528:"Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: Synthesis and meta-analysis of trial data" 2709: 2491:

Hypothermia After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation".

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Scholefield, BR; Silverstein, FS; Telford, R; Holubkov, R; Slomine, BS; Meert, KL; Christensen, JR; Nadkarni, VM; Dean, JM; Moler, FW (3 October 2018).

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help moderate intracranial pressure and therefore to minimize the harmful effects of a patient's inflammatory immune responses during reperfusion. The

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Edwards, A D.; Brocklehurst, P.; Gunn, A. J; Halliday, H.; Juszczak, E.; Levene, M.; Strohm, B.; Thoresen, M.; Whitelaw, A.; Azzopardi, D. (2010).

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Bernard, Stephen A.; Gray, Timothy W.; Buist, Michael D.; Jones, Bruce M.; Silvester, William; Gutteridge, Geoff; Smith, Karen (21 February 2002).

1328:"Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" 666:"Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" 293: 227: 1445:

Polderman KH, Peerdeman SM, Girbes AR (May 2001). "Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury".

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temperature. Water blankets lower a person's temperature exclusively by cooling a person's skin and accordingly require no invasive procedures.

2167:"Intra-Arrest Transnasal Evaporative Cooling: A Randomized, Prehospital, Multicenter Study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness)" 1803:

Choi, H. Alex; Ko, Sang-Bae; Presciutti, Mary; Fernandez, Luis; Carpenter, Amanda M.; Lesch, Christine; Gilmore, Emily; Malhotra, Rishi;

1787: 1721:

Taccone, FS; Donadello, K; Beumier, M; Scolletta, S (2011). "When, where and how to initiate hypothermia after adult cardiac arrest".

2983: 1752: 2871:"Osborn waves following out-of-hospital cardiac arrest—Effect of level of temperature management and risk of arrhythmia and death" 536:, as hypothermia is associated with a lower clotting threshold. In these animal studies, hypothermia was represented an effective 2209:"Safety and feasibility of nasopharyngeal evaporative cooling in the emergency department setting in survivors of cardiac arrest" 2038:"Efficacy of and tolerance to mild induced hypothermia after out-of-hospital cardiac arrest using an endovascular cooling system" 1995:

Holzer, M.; Müllner, M.; Sterz, F.; Robak, O.; Kliegel, A.; Losert, H.; Sodeck, G.; Uray, T.; Zeiner, A.; Laggner, A. N. (2006).

1133:

Arrich, Jasmin; Schütz, Nikola; Oppenauer, Julia; Vendt, Janne; Holzer, Michael; Havel, Christof; Herkner, Harald (22 May 2023).

17: 780:

Arrich, Jasmin; Schütz, Nikola; Oppenauer, Julia; Vendt, Janne; Holzer, Michael; Havel, Christof; Herkner, Harald (2023-05-22).

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from cardiac arrest. Evidence supports its use following certain types of cardiac arrest in which an individual does not regain

1293: 553:

to prevent secondary neurological injuries after severe CNS trauma. A systematic review of randomised controlled trials in

1283: 837:

Lewis, Sharon R.; Evans, David Jw; Butler, Andrew R.; Schofield-Robinson, Oliver J.; Alderson, Phil (September 21, 2017).

2715: 2639:"Cooling for acute ischemic brain damage (cool aid): An open pilot study of induced hypothermia in acute ischemic stroke" 1807:(2011-01-06). "Prevention of Shivering During Therapeutic Temperature Modulation: The Columbia Anti-Shivering Protocol". 1589:

Polderman, Kees H (2008). "Induced hypothermia and fever control for prevention and treatment of neurological injuries".

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Kammersgaard, L.P.; Jørgensen, H.S.; Rungby, J.A.; Reith, J.; Nakayama, H.; Weber, U.J.; Houth, J.; Olsen, T.S. (2002).

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Ferreira Da Silva, IR; Frontera, JA (November 2013). "Targeted temperature management in survivors of cardiac arrest".

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Lewis, Sharon R; Evans, David JW; Butler, Andrew R; Schofield-Robinson, Oliver J; Alderson, Phil (21 September 2017).

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or other physician to perform the insertion may minimize some of the benefit of invasive methods' more rapid cooling.

2412:

Jacobs, Susan E; Berg, Marie; Hunt, Rod; Tarnow-Mordi, William O; Inder, Terrie E; Davis, Peter G (31 January 2013).

2577: 2637:

Krieger, DW; De Georgia, MA; Abou-Chebl, A; Andrefsky, JC; Sila, CA; Katzan, IL; Mayberg, MR; Furlan, AJ (2001).

714: 500: 467: 231: 3011: 2036:

Pichon, Nicolas; Amiel, Jean; François, Bruno; Dugard, Anthony; Etchecopar, Caroline; Vignon, Philippe (2007).

53: 280:

The earliest rationale for the effects of hypothermia as a neuroprotectant focused on the slowing of cellular

2208: 2465: 1632:

Lau, Anthony; Tymianski, Michael (2010-07-01). "Glutamate receptors, neurotoxicity and neurodegeneration".

617:

As of 2015 hypothermia had shown no improvements in neurological outcomes or in mortality in neurosurgery.

395:

Adverse events associated with this invasive technique include bleeding, infection, vascular puncture, and

383:. People should be rewarmed slowly and steadily in order to avoid harmful spikes in intracranial pressure. 581:

of the use of hypothermia for cardiac arrest patients showed favorable neurological outcome and survival.

3066: 1946: 1490:"Admission Body Temperature Predicts Long-Term Mortality After Acute Stroke: The Copenhagen Stroke Study" 2087:

Schwab, S.; Georgiadis, D.; Berrouschot, J.; Schellinger, P. D.; Graffagnino, C.; Mayer, S. A. (2001).

578: 504: 416: 197: 153:. The target temperature is often between 32 and 34 °C. Targeted temperature management following 2575:

Polderman KH (2009). "Mechanisms of action, physiological effects, and complications of hypothermia".

1997:"Efficacy and Safety of Endovascular Cooling After Cardiac Arrest: Cohort Study and Bayesian Approach" 1947:"Endovascular cooling with heat exchange catheters: A new method to induce and maintain hypothermia" 1790:." Therapeutic Hypothermia. Ed. Mayer, Stephen and Sessler, Daniel. Marcel Decker: New York, 2005. 65: 30:

This article is about deliberately induced cooling. For the adverse condition of hypothermia, see

2830: 2680:"Moderate Hypothermia in the Treatment of Patients with Severe Middle Cerebral Artery Infarction" 3032: 230:

has been proven to improve outcomes for newborn infants affected by perinatal hypoxia-ischemia,

755: 602: 554: 298: 154: 1086:"Therapeutic hypothermia after paediatric cardiac arrest: Pooled randomized controlled trials" 2731:"Review Article of the Use of Early Hypothermia in the Treatment of Traumatic Brain Injuries" 972:

Holzer M, et al. (The Hypothermia after Cardiac Arrest Study Group) (21 February 2002).

541: 487: 375:. If shivering is unable to be controlled with these drugs, patients are often placed under 3041: 710:"Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced Hypothermia" 3076: 3071: 396: 157:

is of unclear benefit. While associated with some complications, these are generally mild.

3020: 939: 8: 2975: 2620: 586: 376: 256: 71: 2952: 2925: 2886: 2843: 2249:

Holden, M; Makic, MB (2006). "Clinically induced hypothermia: Why chill your patient?".

2227: 2142: 1423: 1182:

Jacobs, SE; Berg, M; Hunt, R; Tarnow-Mordi, WO; Inder, TE; Davis, PG (31 January 2013).

1159: 1101: 1062: 1027: 814: 781: 2906: 2805: 2780: 2761: 2602: 2552: 2527: 2504: 2438: 2413: 2394: 2345: 2320: 2274: 2064: 2037: 2013: 1996: 1977: 1927: 1883: 1871: 1840: 1657: 1614: 1571: 1506: 1489: 1470: 1392: 1259: 1232: 1208: 1183: 1110: 1085: 920: 871: 838: 707: 533: 407: 380: 313: 2870: 2183: 2166: 1857: 1602: 1344: 1327: 682: 665: 486:, advocated the packing of wounded soldiers in snow and ice. Napoleonic surgeon Baron 2957: 2898: 2890: 2847: 2810: 2753: 2701: 2660: 2594: 2557: 2508: 2443: 2386: 2350: 2321:"Systematic review of head cooling in adults after traumatic brain injury and stroke" 2301: 2266: 2262: 2231: 2188: 2146: 2110: 2089:"Feasibility and Safety of Moderate Hypothermia After Massive Hemispheric Infarction" 2069: 2018: 1969: 1919: 1875: 1832: 1824: 1764: 1730: 1703: 1649: 1606: 1563: 1511: 1462: 1427: 1384: 1349: 1289: 1264: 1213: 1164: 1115: 1066: 1031: 995: 974:"Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest" 912: 876: 858: 819: 801: 733: 687: 2910: 2765: 2398: 2278: 1981: 1931: 1844: 1661: 1474: 1396: 924: 58: 2947: 2942: 2937: 2882: 2839: 2800: 2796: 2792: 2745: 2691: 2650: 2606: 2586: 2547: 2539: 2500: 2433: 2429: 2425: 2378: 2340: 2332: 2258: 2223: 2178: 2138: 2100: 2059: 2049: 2008: 1961: 1911: 1867: 1816: 1804: 1695: 1641: 1618: 1598: 1575: 1555: 1501: 1454: 1419: 1376: 1339: 1254: 1244: 1203: 1199: 1195: 1154: 1150: 1146: 1105: 1097: 1058: 1023: 985: 904: 866: 854: 850: 809: 797: 793: 723: 677: 483: 317: 260: 161: 123: 119: 2730: 2678:

Schwab, S.; Schwarz, S.; Spranger, M.; Keller, E.; Bertram, M.; Hacke, W. (1998).

478:

Hypothermia has been applied therapeutically since antiquity. The Greek physician

212:

In children, following cardiac arrest, cooling does not appear useful as of 2018.

3015: 2590: 2382: 1915: 1887: 1380: 1134: 605:, and may be considered a benign physiological phenomenon, associated with lower 537: 529: 368: 216: 206: 127: 908: 1458: 606: 594: 574: 566: 508: 463: 235: 145:

Targeted temperature management improves survival and brain function following

131: 2696: 2679: 2367: 1965: 1820: 1699: 1645: 1559: 3060: 2894: 2655: 2638: 1828: 862: 805: 305: 150: 146: 84: 3037: 2961: 2902: 2851: 2814: 2757: 2664: 2598: 2561: 2512: 2447: 2390: 2354: 2305: 2270: 2235: 2192: 2150: 2114: 2073: 2022: 1973: 1923: 1879: 1836: 1768: 1734: 1707: 1653: 1610: 1567: 1515: 1466: 1431: 1388: 1353: 1268: 1249: 1217: 1168: 1119: 1070: 1035: 999: 916: 880: 823: 737: 691: 626: 570: 326: 169: 2705: 2105: 2088: 1012: 990: 973: 728: 709: 479: 411: 352: 184:

Targeted temperature management may be used in the following conditions:

31: 544:(ICP) after an ischemic stroke was found to be both safe and practical. 288:

In the special case of infants with perinatal asphyxia, it appears that

2749: 281: 2722: 2086: 93: 2625: 2543: 2336: 1282:

Betts, J. Gordon (25 April 2013). "1.4 Requirements for Human Life".

1083: 364: 356: 322: 289: 264: 165: 118:

is an active treatment that tries to achieve and maintain a specific

3008: 2867: 2636: 940:"Targeted temperature management following cardiac arrest An update" 557:(TBI) suggests there is no evidence that hypothermia is beneficial. 2054: 1751:

Calver, P; Braungardt, T; Kupchik, N; Jensen, A; Cutler, C (2005).

372: 339:

the process, further methods are required to keep the person cold.

135: 2778: 2319:

Harris, B; Andrews, PJ; Murray, GD; Forbes, J; Moseley, O (2012).

836: 2980:— Primary Amebic Meningoencephalitis (PAM) — Amebic Encephalitis" 1237:

International Journal of Environmental Research and Public Health

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Keller, E; Imhof, HG; Gasser, S; Terzic, A; Yonekawa, Y (2003).

1720: 1487: 1135:"Hypothermia for neuroprotection in adults after cardiac arrest" 782:"Hypothermia for neuroprotection in adults after cardiac arrest" 2525: 1409: 598: 582: 450: 360: 268: 173: 139: 2163: 1750: 1324: 662: 193: 2489: 2414:"Cooling for newborns with hypoxic ischaemic encephalopathy" 1184:"Cooling for newborns with hypoxic ischaemic encephalopathy" 2677: 2205: 403: 2411: 1366: 1181: 1132: 779: 2621:

Targeted Temperature Management (Therapeutic Hypothermia)

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Possible complications may include: infection, bleeding,

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work. Licensed under CC BY 4.0. Text taken from

1753:"The big chill: Improving the odds after cardiac arrest" 1444: 547: 312:

Targeted temperature management may also help to reduce

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Galvin IM, Levy R, Boyd JG, Day AG, Wallace MC (2015).

1994: 1944: 1230: 2926:"Cooling for cerebral protection during brain surgery" 1900: 330:

neuronal death via the mechanisms of excitotoxicity.

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Notably, even a small drop in temperature encourages

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cardiac arrest. There is no difference in long term

597:, particularly in patients treated with 33 °C. 3021:Therapeutic Hypothermia and Temperature Management 2923: 1233:"The Role of Deep Hypothermia in Cardiac Surgery" 422: 3058: 2827: 209:following mild compared to more severe cooling. 2459: 2457: 1851: 1634:Pflügers Archiv: European Journal of Physiology 1320: 1318: 1316: 1314: 1312: 294:hypothermia therapy for neonatal encephalopathy 228:Hypothermia therapy for neonatal encephalopathy 2729:Arcure, Jess; Harrison, Eric E (Summer 2009). 2728: 2291: 1938: 752:"Therapeutic Hypothermia After Cardiac Arrest" 325:that occurs during reperfusion also increases 893: 703: 701: 3036: This article incorporates text from a 3009:The American Society of Hypothermic Medicine 2821: 2574: 2568: 2454: 1631: 1309: 292:is a prominent cause of cell death and that 2463: 2248: 1188:The Cochrane Database of Systematic Reviews 1048: 967: 965: 963: 843:The Cochrane Database of Systematic Reviews 786:The Cochrane Database of Systematic Reviews 379:and/or are given paralytic medication like 130:. Periods of poor blood flow may be due to 1782: 1780: 1778: 1681: 1679: 1677: 1675: 1673: 1671: 937: 698: 601:are not associated with increased risk of 569:patients showed that hypothermia improved 222: 2951: 2941: 2804: 2695: 2654: 2551: 2437: 2344: 2182: 2157: 2104: 2063: 2053: 2012: 1588: 1545: 1505: 1343: 1258: 1248: 1207: 1158: 1109: 989: 870: 813: 727: 681: 658: 656: 654: 2781:"Hypothermia for traumatic brain injury" 2285: 1894: 1746: 1744: 1275: 960: 931: 839:"Hypothermia for traumatic brain injury" 263:. One review found an increased risk of 2785:Cochrane Database of Systematic Reviews 2418:Cochrane Database of Systematic Reviews 1904:Journal of Neurosurgical Anesthesiology 1775: 1668: 1541: 1539: 1537: 1535: 1533: 1531: 1529: 1527: 1525: 1139:Cochrane Database of Systematic Reviews 887: 14: 3059: 2738:Journal of Special Operations Medicine 2242: 971: 651: 2986:from the original on 14 February 2015 2863: 2861: 2121: 1741: 1281: 548:Traumatic brain or spinal cord injury 241: 2613: 1522: 775: 773: 540:. The use of hypothermia to control 386: 2887:10.1016/j.resuscitation.2018.04.037 2844:10.1016/j.resuscitation.2011.08.005 2228:10.1016/j.resuscitation.2010.04.027 2143:10.1016/j.resuscitation.2007.03.001 2080: 1481: 1424:10.1016/j.resuscitation.2014.07.018 1102:10.1016/j.resuscitation.2018.09.011 1063:10.1016/j.resuscitation.2016.03.024 1028:10.1016/j.resuscitation.2015.02.038 639:Deep hypothermic circulatory arrest 625:TTM has been used in some cases of 560: 24: 2858: 2505:10.1161/01.CIR.0000079019.02601.90 2014:10.1161/01.STR.0000227265.52763.16 1872:10.1097/01.CCM.0000108868.97433.3F 1507:10.1161/01.STR.0000019910.90280.F1 250: 134:or the blockage of an artery by a 25: 3088: 3002: 2184:10.1161/CIRCULATIONAHA.109.931691 1788:Thermoregulation and Heat Balance 1345:10.1161/CIRCULATIONAHA.110.971002 770: 683:10.1161/CIRCULATIONAHA.110.971002 435: 187: 3031: 2263:10.1097/00044067-200604000-00007 593:) are frequent during TTM after 2968: 2917: 2772: 2671: 2630: 2519: 2483: 2405: 2361: 2312: 2199: 2029: 1988: 1796: 1714: 1625: 1582: 1438: 1403: 1360: 1224: 1175: 1126: 1077: 1042: 978:New England Journal of Medicine 715:New England Journal of Medicine 620: 612: 501:New England Journal of Medicine 468:hypoxic ischemic encephalopathy 232:hypoxic ischemic encephalopathy 179: 104:Targeted temperature management 40:Targeted temperature management 3043:Anatomy and Physiology 2943:10.1002/14651858.CD006638.pub3 2797:10.1002/14651858.CD001048.pub5 2464:Ron Winslow (6 October 2009). 2430:10.1002/14651858.CD003311.pub3 1200:10.1002/14651858.CD003311.pub3 1151:10.1002/14651858.CD004128.pub5 1006: 855:10.1002/14651858.CD001048.pub5 830: 798:10.1002/14651858.CD004128.pub5 744: 423:Transnasal evaporative cooling 13: 1: 1603:10.1016/S0140-6736(08)60837-5 644: 2591:10.1097/CCM.0b013e3181aa5241 2466:"How Ice Can Save Your Life" 2383:10.3109/0284186X.2012.658966 2325:Health Technology Assessment 1916:10.1097/ANA.0b013e318032a208 1381:10.1097/CCM.0b013e3182a276e8 456: 275: 7: 2251:AACN Advanced Critical Care 938:Ian Jacobs (Dec 17, 2013). 909:10.1136/emermed-2012-201120 632: 514: 10: 3093: 3026: 2930:Cochrane Database Syst Rev 1459:10.3171/jns.2001.94.5.0697 897:Emergency Medicine Journal 505:American Heart Association 473: 417:interventional radiologist 333: 198:American Heart Association 29: 2697:10.1161/01.STR.29.12.2461 1966:10.1007/s00134-003-1685-3 1821:10.1007/s12028-010-9474-7 1700:10.1016/j.ccl.2013.07.010 1646:10.1007/s00424-010-0809-1 1560:10.1007/s00134-003-2152-x 609:in univariable analyses. 522: 90: 78: 64: 52: 44: 39: 2656:10.1161/01.STR.32.8.1847 1338:(18 Suppl 3): S768–786. 676:(18 Suppl 3): S768–786. 1954:Intensive Care Medicine 1723:Minerva Anestesiologica 1548:Intensive Care Medicine 223:Neonatal encephalopathy 112:therapeutic hypothermia 48:Therapeutic hypothermia 18:Therapeutic hypothermia 3046:, J. Gordon Betts 2578:Critical Care Medicine 1860:Critical Care Medicine 1369:Critical Care Medicine 1285:Anatomy and Physiology 1250:10.3390/ijerph18137061 756:Johns Hopkins Medicine 603:ventricular arrhythmia 555:traumatic brain injury 482:, the namesake of the 168:, as well as reducing 155:traumatic brain injury 116:protective hypothermia 110:) previously known as 2585:(7 Suppl): S186–202. 2106:10.1161/hs0901.095394 1763:(5): 58–62, quiz 63. 542:intracranial pressure 488:Dominique Jean Larrey 991:10.1056/NEJMoa012689 729:10.1056/NEJMoa003289 573:outcome and reduced 565:A clinical trial in 466:in babies born with 397:deep vein thrombosis 138:as in the case of a 2470:Wall Street Journal 1597:(9628): 1955–1969. 579:retrospective study 371:, fentanyl, and/or 316:, damage caused by 3067:Medical treatments 3014:2011-07-23 at the 2750:10.55460/6EAQ-Z4AP 1809:Neurocritical Care 1786:Sessler, Daniel. " 1694:(4): 637–655, ix. 1688:Cardiology Clinics 534:hemorrhagic stroke 408:pulmonary embolism 377:general anesthesia 314:reperfusion injury 242:Open heart surgery 128:lack of blood flow 2982:. 23 April 2015. 2978:Naegleria fowleri 2690:(12): 2461–2466. 1805:Mayer, Stephan A. 1418:(11): 1494–1503. 1295:978-1-947172-04-3 587:electrocardiogram 387:Cooling catheters 162:neurotransmitters 126:injury following 101: 100: 80:OPS-301 code 27:Medical procedure 16:(Redirected from 3084: 3035: 2996: 2995: 2993: 2991: 2972: 2966: 2965: 2955: 2945: 2921: 2915: 2914: 2865: 2856: 2855: 2825: 2819: 2818: 2808: 2776: 2770: 2769: 2735: 2726: 2720: 2719: 2714: 2699: 2675: 2669: 2668: 2658: 2649:(8): 1847–1854. 2634: 2628: 2617: 2611: 2610: 2572: 2566: 2565: 2555: 2544:10.1136/bmj.c363 2523: 2517: 2516: 2487: 2481: 2480: 2478: 2476: 2461: 2452: 2451: 2441: 2409: 2403: 2402: 2365: 2359: 2358: 2348: 2337:10.3310/hta16450 2316: 2310: 2309: 2289: 2283: 2282: 2246: 2240: 2239: 2213: 2203: 2197: 2196: 2186: 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