**Author details**

Rekha Lakshmanan, Farid Sadaka and Ashok Palagiri *Mercy Hospital St. Louis, Missouri, USA* 

#### **14. References**

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Therapeutic Hypothermia: Adverse Events, Recognition, Prevention and Treatment Strategies 19

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[22] Cheong KF, Chen FG, Yau GH. Postanaesthetic shivering--a comparison of thiopentone

[23] Leslie K, Sessler DI, Bjorksten AR, Moayeri A. Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg

[24] Stoner J, Martin G, O'Mara K, et al. Amiodarone and bretylium in the treatment of

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[27] Dixon SR, Whitbourn RJ, Dae MW, et al. Induction of mild systemic hypothermia with endovascular cooling during primary percutaneous coronary intervention for acute

[28] Mongardon, N et al. Infectious complications in out-of-hospital cardiac arrest patients

[29] Kimura A, Sakurada S, Ohkuni H,Todome Y, Kurata K (2002) Moderatehypothermia

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[31] Aibiki M, Maekawa S, Ogura S, Kinoshita Y, Kawai N, Yokono S (1999) Effect of moderate hypothermia on systemic and internal jugular plasma IL-6 levels after

[32] Low, Evonne; Boylan, Geraldine; Mathieson, Sean R; Murray, Deirdre M; Korotchikova, Irina; Stevenson, Nathan J; Livingstone, Vicki; Rennie, Janet M Cooling and seizure burden in term neonates: an observational study Archives of Disease in Childhood:

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[34] Meierkord H, Boon P, Engelsen B, et al. EFNS guideline on the management of status

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[36] Schefold JC, Storm C, Joerres A, Hasper D. Mild therapeutic hypothermia after cardiac arrest and the risk of bleeding in patients with acute myocardial infarction.

[37] Watts DD, Trask A, Soeken K, et al. Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic

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[7] Bernard, S. et al. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: A preliminary report.

[8] Soga, T. et al. Mild therapeutic hypothermia using extracorporeal cooling method in comatose survivors after out-of-hospital cardiac arrest. Circulation 2006;114:II-1190 [9] Badjatia N, Strongilis E, Gordon E, et al. Metabolic impact of shivering during therapeutic modulation: the Bedside Shivering Assessment Scale. Stroke. 2008;39:3242–

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#### **Additional References:**

Therapeutic Hypothermia for Neuroprotection Emerg Med Clin North Am. 2009 Feb;27(1):137- 49, ix.C. Jessica Dine, MDa, Benjamin S. Abella, MD, MPhi

**Section 2** 

**Therapeutic Hypothermia-Cardiac Arrest** 


**Therapeutic Hypothermia-Cardiac Arrest** 

20 Therapeutic Hypothermia in Brain Injury

Therapeutic Hypothermia for Neuroprotection Emerg Med Clin North Am. 2009 Feb;27(1):137-

Do Standard Monitoring Sites Reflect True Brain Temperature When Profound Hypothermia Is Rapidly Induced and Reversed?. Stone, Gilbert J. MD; Young, William L. MD; Smith, Craig R. MD; Solomon, Robert A. MD; Wald, Alvin PhD; Ostapkovich, Noeleen REPT;

Gaussorgues P, et al. Bacteremia following cardiac arrest and cardiopulmonary

Cueni-Villoz N, et al. Increased blood glucose variability during therapeutic hypothermia

49, ix.C. Jessica Dine, MDa, Benjamin S. Abella, MD, MPhi

resuscitation. *Intensive Care Med* 1988;14(5):575-7.

Shrebnick, Debra B. PA Anesthesiology. 82(2):344-351, February 1995.

and outcome after cardiac arrest. *Crit Care Med* 2011;39(10):2225-31.

**Additional References:** 

**Chapter 2** 

© 2013 Sadaka, 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 Sadaka, 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 for Cardiac Arrest** 

In the era before Therapeutic Hypothermia (TH) was recommended and used as a therapeutic modality for out-of-hospital cardiac arrest (OHCA) patients, reported data suggests in-hospital mortality exceeded 58%.[1,2,3,4,5,6] Mortality after a sudden and unexpected cardiac arrest (CA) is high, and the chance of survival to hospital discharge has, until recently, remained unchanged.[7] In one report, OHCA in the U.S. has a mortality rate greater than 90% which results in more than 300,000 deaths per year.[8] Those who survive the devastating event, often retain a hypoxic brain injury and a permanently incapacitating neurologic deficit.[9] Studies of patients who survived to ICU admission but subsequently died in the hospital, brain injury was the cause of death in 68% after out-of-hospital cardiac arrest and in 23% after in-hospital cardiac arrest.[10,11] Therapeutic hypothermia, or targeted temperature management, is a therapeutic intervention that is intended to limit neurologic

A cascade of destructive events and processes begins at the cellular level in the minutes to hours following an initial injury. These processes, the result of ischemia and reperfusion, may continue for hours to many days after the initial injury.[12] It is crucial to note that all of these processes after ischemic-reperfusion injury in the brain are temperature dependent; they are all stimulated by fever, and can all be mitigated or blocked by hypothermia. Since most of these processes start within minutes to hours after the injury, then application of hypothermia earlier might be even more beneficial than conventional later application.

When hypothermia was first used in a clinical setting it was presumed that its protective effects were due purely to a slowing of cerebral metabolism, leading to reduced glucose and

Farid Sadaka

http://dx.doi.org/10.5772/49374

**1. Introduction** 

Additional information is available at the end of the chapter

injury after a patient's resuscitation from cardiac arrest.

**2. Mechanisms of neuroprotection** 

**2.1. Slowing of brain metabolism** 
