Current Development and Clinical Usage of Therapeutic Hypothermia

Therapeutic hypothermia was first applied to clinical use in the 1940s, but was complicated by severe adverse effects at deep hypothermic temperatures. However, many animal studies have revealed that it has strong neuroprotective effects to reduce brain damage. In 2002, two multi-center randomized clinical trials which applied mild to moderate hypothermia to out-of-hospital cardiac arrest patients with cardiogenic etiologies, proved the significant benefits of the neuroprotective effect and even improvement of mortality. Currently, therapeutic hypothermia is viewed as a new strategy for organ protection in the intensive care field. Many clinical trials have examined the safety, feasibility, and efficacy of therapeutic hypothermia in different etiologies with complications with brain damage such as perinatal asphyxia, acute stroke, traumatic brain injury or acute hepatic failure with cerebral edema and spinal cord injury. Other possible applications of therapeutic hypothermia include myocardioprotection and multiple organ protection in systemic inflammatory processes such as hemorrhagic shock and sepsis. Successful application of therapeutic hypothermia depends on a sensitive, stable and etiology dependent temperature control protocol with intensive care of multiple alternative physiological and adverse effects. This is probably why therapeutic hypothermia is still not popular in Taiwan or worldwide. The aim of this study was to provide a brief review of the current use of therapeutic hypothermia in different etiologies and mechanisms, clinical management of adverse effects and the other significant physiological changes during temperature change, and some details of temperature control techniques to promote a greater understanding and usage of therapeutic hypothermia.