Blog Viewer

Harnessing the potential benefits of therapeutic hypothermia in patients with acute brain injury

By Currents Editor posted 01-19-2022 11:08

  

Yingying Su, Guoping Ren, Linlin Fan, and Huijin Huang

The functional recovery of nerve cells after brain injury is extremely complex and difficult. Finding effective ways to save as many nerve cells as possible while retaining and maximizing neural function has become a common goal for neuroscientists, neurologists, and medical engineers worldwide. Among available interventions, therapeutic hypothermia (TH) and targeted temperature management (TTM) in the early phases of acute brain injury have shown some promise as effective neuroprotective treatments. The neuro ICU team at Xuanwu Hospital at Capital Medical University has been committed to the clinical study of TH and TTM for at least 15 years. We found that early hypothermia treatment (with or without partial skull resection) can improve the neurological prognosis of stroke survivors with large hemispheric infarction. There is also a role for TH in patients with refractory status epilepticus, as hypothermia can quickly terminate or significantly reduce epileptic seizures when conventional treatment with anesthetics and antiepileptic drugs fails to achieve seizure termination. However, a more rigorous, evidence-based, systematic and standardized approach is needed to optimize potential benefits for patients with acute brain injury.  

On August 26-27, 2021, Professor Yingying Su, an academic leader of Chinese neurocritical care, was invited to participate in the 11th Annual Conference on global TH and TTM hosted by the Keck Medical School at the University of Southern California (USC). Even though the vast Pacific Ocean stood between Beijing and Los Angeles, a spirited dialogue took place via teleconference, riding the waves of wireless electromagnetic signals. 

Professor Dr. Patrick Lyden, an internationally renowned stroke expert and the headlining speaker of the conference, delivered an opening speech welcoming medical experts from the United States, Europe, and China. In his talk, he emphasized the importance of TH and TTM in a variety of clinical practice settings, while setting the tone for future research directions. 

In Professor Yingying Su’s talk, she shared the research progress of hypothermia treatment in China with experts in relevant fields around the world, and stressed the following directions for follow-up efforts: (1) Expand the types of diseases studied (ischemic stroke, ischemic hypoxic encephalopathy, traumatic brain injury, status epilepticus, increased intracranial pressure, etc.) to potentially benefit more patients with severe neurological diseases; (2) Increase  sample sizes across studies (via multiple single-center studies or multi-center studies) to obtain more accurate and reliable evidence to guide clinical practice; (3) Promote systematic and standardized approaches using high-quality evidence to implement TH and TTM (e.g., The Consensus of Chinese Experts on Hypothermia Treatment of Neurological Diseases within China); (4) Strengthen the development of medical teams and systems focused on TH and TTM to improve overall quality of care. 

In the next 5-10 years, the Chinese neurocritical care team plans to strengthen communication and scientific exchanges with global medical teams in relevant fields, with the goal of contributing to improvements in neurocritical care via enhanced TH and TTM practice.  

#LeadingInsights

​​
FURTHER READING
Ita Muharram Sari, MD National Brain Center Prof. Dr. Mahar Mardjono Hospital (NBC) is the main referral hospital specializing in brain and nervous systems under the Ministry of Health Republic of Indonesia. As a center of excellence, NBC gives advanced clinical practice on neurological diseases, education, ...
Jiping Zhou, MD, MPH PGY-3 resident in Neurology Wayne State University/Detroit Medical Center Wazim Mohamed, MD Associate Professor of Neurology and Neurosurgery Wayne State University R oberg, Lars Egil, et al. "Prediction of Long-term Survival After Status Epilepticus Using the ACD ...
Renad Abu-Sawwa, PharmD, BCPPS University of Florida, College of Pharmacy “When you adjust for hypoalbuminemia, his phenytoin level was therapeutic at 17.5 mcg/mL following his fosphenytoin load. In addition to starting maintenance phenytoin, I would recommend initiating ketamine rather than pentobarbital ...