**Acknowledgement**

No additional acknowledgements.

## **Conflicts of Interest**

The author reports no conflicts of interest.

The author declares that No competing financial interests exist.

The author reports that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

#### **8. References**


[4] Nolan JP, Laver SR, Welch CA, Harrison DA, Gupta V, Rowan K (2007) Outcome following admission to UK intensive care units after cardiac arrest: a secondary analysis of the ICNARC Case Mix Programme Database. Anaesthesia 62:1207–1216.

42 Therapeutic Hypothermia in Brain Injury

cardiac arrest bundle of care are needed.

**Author details** 

**Acknowledgement** 

**Conflicts of Interest** 

**8. References** 

No additional acknowledgements.

The author reports no conflicts of interest.

The author declares that No competing financial interests exist.

whose products or services may be discussed in this article.

who you are. Crit Care Med 35: 836–841.

Farid Sadaka

*USA* 

that are not staffed by physicians, transport to facilities that are not equipped to continue inhospital therapeutic hypothermia and postresuscitation care, the potential for overcooling and shivering, and interference with basic resuscitation efforts in the field. Intraarest and postarrest bundles of care that include therapeutic hypothermia, as well as training of EMS teams, EMS physicians, emergency room staff, cardiologists and cardiac catheterization lab staff, and intensive care unit physicians and staff on these protocols and bundles are crucial for the success of these bundles and the implementation of this important therapy, whether cooling is initiated in the field or in the hospital setting. Clearly, large prospective randomized controlled trials of prehospital therapeutic hypothermia preferably as part of a

*Mercy Hospital St Louis/St Louis University, Critical Care Medicine/Neurocritical Care, St Louis,* 

The author reports that no potential conflicts of interest exist with any companies/organizations

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**Section 3** 

**Therapeutic Hypothermia-Stroke / SCI** 


**Therapeutic Hypothermia-Stroke / SCI** 

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**Chapter 4** 

© 2013 Samaniego, licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 Samaniego, licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**Therapeutic Hypothermia in Acute Stroke** 

Stroke is the second most common cause of death and a major cause of serious long-term disability in adults in industrialized countries. Approximately 90% of strokes are ischemic and the rest are hemorrhagic.[1] Unfortunately, few effective treatments can be offered during the acute and subacute phases. Since the introduction of tissue plasminogen activator (tPA) in 1995, there are no other medical treatments for ischemic stroke besides the use of antiplatelets for primary and secondary prevention. Moreover, the clinical treatments

In ischemic stroke most of therapies aim to recanalize the vessel and restore flow through pharmacological or endovascular treatments. However, another approach to preserve brain tissue is through the interruption of catalytic pathways triggered by ischemia. Rapid restoration of oxygen and glucose by thrombolysis will always provide the most effective neuroprotection, but directly targeting the brain parenchyma to confer neuroprotection may be a viable alternative, particularly in conjunction with thrombolysis. Multiple pharmacological attempts have failed in finding an ideal neuroprotective agent. Over 1000 neuroprotective agents have been tested in basic stroke studies with many showing promise.[2] However, to date no neuroprotective agent has successfully transitioned from bench or animal studies into clinical use. Although cooling may be unable to salvage neural tissue that has irreversibly progressed to infarction, hypothermia minimizes the extent of secondary injury as an acute or subacute treatment strategy. Hypothermia is increasingly being used, especially since therapeutic mild hypothermia has demonstrated to positively influence neurological outcome in humans following acute brain injuries, namely, global ischemic brain injury due to cardiac arrest and hypoxic-ischemic encephalopathy in

Catalytic cascades are generated in the brain tissue surrounding a blood clot after intracerebral hemorrhage (ICH). Hypothermia may also be used as a neuroprotection

Edgar A. Samaniego

http://dx.doi.org/10.5772/51071

for hemorrhagic stroke are also limited.

**1. Introduction** 

neonates.[3, 4]

Additional information is available at the end of the chapter
