Therapeutic Hypothermia


Indications

Hypoxic-Ischemic Brain Injury (see Hypoxic-Ischemic Brain Injury)

Cardiac Arrest (see Cardiac Arrest)

Intracerebral Hemorrhage (Hemorrhagic CVA) (see Intracerebral Hemorrhage)

Intoxication

Ischemic Cerebrovascular Accident (CVA) (see Ischemic Cerebrovascular Accident)

Severe Hypoxemia (see Hypoxemia)

Subarachnoid Hemorrhage (SAH) (see Subarachnoid Hemorrhage)

Traumatic Brain Injury (TBI) (see Traumatic Brain Injury)


Contraindications


Physiology

Physiologic Effects of Therapeutic Hypothermia

Cardiovascular

Neurologic


Technique


Adverse Effects/Complications During Cooling

Cardiovascular Adverse Effects

Arrhythmias

Decreased Cardiac Output

Peripheral Vasoconstriction

Endocrinologic Adverse Effects

Hyperglycemia (see Hyperglycemia)

Hematologic Adverse Effects

Coagulopathy (see Coagulopathy)

Hemoconcentration

Infectious Adverse Effects

Increased Risk of Infection

Renal Adverse Effects

“Cold Diuresis”

Other Adverse Effects

Decreased Metabolism/Excretion of Medications

No Effect on Vasopressor Requirement

Impairment of the Prognostic Utility of Somatosensory Evoked Potentials and Serum Neuron-Specific Enolase (NSE) (see Somatosensory Evoked Potentials and Serum Neuron-Specific Enolase) (Crit Care Med, 2012) [MEDLINE] (Ann Neurol, 2010) [MEDLINE]


Adverse Effects/Complications During Rewarming

Cardiovascular Adverse Effects

Increased Oxygen Consumption

Hypotension (see Hypotension)

Endocrinologic Adverse Effects

Hypoglycemia (see Hypoglycemia)

Renal Adverse Effects

Hyperkalemia (see Hyperkalemia)

Other Adverse Effects

Rebound Increase in Intracranial Pressure (ICP) (see Increased Intracranial Pressure)

Rebound Increase in Body Temperature


References

General

Indications

Cardiac Arrest (see Cardiac Arrest)

Ischemic Cerebrovascular Accident (CVA) (see Ischemic Cerebrovascular Accident)

Traumatic Brain Injury (see Traumatic Brain Injury)

Adverse Effects