Clinical research and technological developments are expanding the potential applications in which this innovative approach help improve outcomes.
Published studies in leading medical journals, including the New England Journal of Medicine,2,3 Stroke,4 Neurosurgery,5 Critical Care Medicine,6 and Neurocritical Care7 are providing insights into an expanding range of potential TMT applications, including stroke, acute myocardial infarction, sudden cardiac arrest, and fever control. These studies demonstrate the clinical impact of temperature modulation therapy for protecting critical organs following cardiac arrest, myocardial infarction (prior to revascularization), and other traumatic injury, as well as protecting the brain of hemorrhage patients.
Momentum is building for the use of TMT in clinical practice with support coming from ground-breaking recommendations from both the American Heart Association and the International Liaison Committee on Resuscitation.8,9
Technological advances are helping drive the potential of new patient applications. Previously, only rudimentary surface cooling options, such as ice packs or blankets, were available to support temperature modulation therapy protocols. Advances in surface cooling technologies, specifically around pad design, have improved surface contact and the critical heat exchange process, as well as made these technologies easier to use. The availability of innovative endovascular systems that can be easily set up and used on non-paralyzed, awake patients also has broadened the types of patients who can benefit from temperature modulation therapy.
References
1 Bigelow WG, Callaghan JC, Hopps JA. General hypothermia for experimental intracardiac surgery; the use of electrophrenic respirations, an artificial pacemaker for cardiac standstill and radio-frequency rewarming in general hypothermia. Ann Surg. 1950;132(3):531–539.
2 Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Eng J Med. 2002;346:557-563.
3 The Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve neurological outcome after cardiac arrest. N Eng J Med. 2002;346:549-556.
4 Holzer M, Mullner M, Sterz F, et al. Efficacy and safety of endovascular cooling after cardiac arrest: Cohort study and Bayesian approach. Stroke. 2006;37:1792-1797.
5 Steinberg GK, Ogilvy CS, Shuer LM, et al. Comparison of endovascular and surface cooling during unruptured cerebral aneurysm repair. Neurosurgery. 2004;55:307-315.
6 Oddo M, Schaller MD, Feihl F, et al. From evidence to clinical practice, effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med. 2006;34:1865-1873.
7 Badjatia N, O’Donnell J, Baker JR, et al. Achieving normothermia in patients with febrile subarachnoid hemorrhage. Feasibility and safety of a novel intravascular cooling catheter. Neurocritical Care. 2004;1:145-156.
8 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 7.5: Postresuscitation Support. Circulation. 2005;112:IV-84-IV-88.
9 Nolan JP, Morely PT, Hoek TL, et al. Therapeutic hypothermia after cardiac arrest: An advisory statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation. Resuscitation. 2003;57:231-235.