Learn what therapeutic hypothermia is and how it can help people with a severe TBI immediately following the initial impact of injury.
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Therapeutic hypothermia is
a treatment for
a variety of things
and in the case that I'm interested in, for brain injury.
I became interested in therapeutic hypothermia approximately 2 decades ago,
when I was working with a fellow named Guy Clifton
at the Medical College of Virginia.
And Guy was demonstrating that in
animal models,
cooling the animal to about 89 degrees Fahrenheit,
or 32 degrees Centigrade,
could make a big difference in the outcome of that animal
after the animal had had an experimental head injury.
So that, I thought, was
an important breakthrough because we knew
that cooling to lower temperatures
could cause some real problems with the heart,
and particularly can cause the heart to stop beating.
Additionally, cooling to low temperatures can
cause problems with coagulation of the blood so that there will be hemorrhage problems.
So I thought that was an important breakthrough
and something that could be accomplished in the clinic
and in the hospital setting.
So I began using hypothermia at that point
when I returned to the clinical practice.
We did a number of studies--myself and a number of other investigators--
did studies with hypothermia,
primarily for patients with severe, traumatic brain injury.
And by that I mean patients who were comatose
following the initial impact
and were brought to our emergency department unable to follow commands
or to interact with their environment.
We think that cooling helps
to improve outcomes
following brain injury
from a variety of causes.
So you can have brain injury as a result of
cardiac arrest, for example, where there's a
loss of blood flow to the brain for a period of time.
You can have brain injury from a stroke.
But more relevant to my clinical interests,
you can have brain injury from an impact to the head,
or trauma, or traumatic brain injury.
And that injury, whether it's from stroke or cardiac arrest or trauma,
will cause a period of ischemia,
or lack of oxygen supply to the brain,
followed by inflammation,
release of a number of toxic chemicals into the brain,
and disruption of the
metabolism or the mechanics of the brain.
All of those things, we think, can be improved with cooling.
Produced by Noel Gunther and Brian King, BrainLine.
Donald Marion, MD, MSc is director of Clinical Affairs, The Defense and Veterans Brain Injury Center, and contractor with the Henry M. Jackson Foundation for the Advancement of Military Medicine. He is an academic neurosurgeon who has focused on the clinical pathophysiology and treatment of traumatic brain injury for more than 25 years.
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