Induced hypothermia in the management of head trauma: A literature review
Ravenscroft, Tristan
Ravenscroft, Tristan
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Abstract
Abstract published with permission.
Mild hypothermia treatment (MHT) involves a controlled decrease of core
temperature in order to mitigate the secondary damage to organs that follows
post primary injury. In the case of traumatic brain injury (TBI) suggestions
that the brain could be conserved by cooling go back as far as the 1940s.
The idea was to reduce cerebral metabolism and hypoxic insult by using MHT.
However, more recent research suggests that this is a ‘simplistic view’ of
brain cooling when there is in fact a much more complex web of effects that
need to be understood and accounted. There clearly needs to be a variety of
multi-disciplinary team based simultaneous pre-hospital and then in-hospital
treatments to ameliorate harm (Nonmaleficence ) and enhance brain healing
processes (Beneficence). Examination will take place of the varied probable
mechanisms of action and contemporary evidence for and against the use of
MHT in TBI. Discussion will range across issues such as target range of MHT,
time to achieve this range, duration of cooling, and finally re-warming rates
on neurological outcomes following TBI. This in turn, should create a clearer
evidence base, for the UK paramedic practitioner who is considering using MHT
in the pre-hospital setting in the minutes following TBI and inform decisions
around: methods and timing of cooling; shivering prevention using sedation;
reliable on-going monitoring of core temperature and team building with
hospital services.