Beyond its uses in cardiac arrest, therapeutic hypothermia has a million and one uses. It has been used to decrease raised intracranial pressure in traumatic brain injury and hepatic encephalopathy; it is being investigated in the management of stroke, and it has known decades of effective use in the operating theatre, allowing safe circulatory arrest to take place in people who are having their aortic root repaired.
This has appeared in the exam twice:
In their comments regarding Question 9 from the first paper of 2015, the examiners lamented their trainees' unfamiliarity with the more outré applications of therapeutic hypothermia. This chapter is a summary of all such uses, and some of the evidence behind them. If one digs deep enough, one is able to unearth many more indications than the college could have possibly included in their model answer. Of course, this also means that the exam candidate will probably not benefit from knowing very much about the more bizarre indications. Beyond the first four or five subheadings lies an evidence-free territory.
The more traditional uses of TH are discussed in separate chapters:
The resources used to construct this list of indications were many and varied. An early article by Kees Polderman (2004) is twelve years out of date now, but is still interesting because it lists the suggested indications in exactly the same order as the college model answer to Question 9. It's always nice to read the same material as the examiners.
Without going into too much detail, intraoperative uses of TH have included the following:
Polderman, Kees H. "Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1: Indications and evidence." Intensive care medicine 30.4 (2004): 556-575.
Seule, M., et al. "Therapeutic hypothermia reduces middle cerebral artery flow velocity in patients with severe aneurysmal subarachnoid hemorrhage." Neurocritical care 20.2 (2014): 255-262.
Gasser, Stefan, et al. "Long‐Term Hypothermia in Patients with Severe Brain Edema After Poor‐Grade Subarachnoid Hemorrhage Feasibility and Intensive Care Complications." Journal of neurosurgical anesthesiology 15.3 (2003): 240-248.
Karnatovskaia, Lioudmila V., et al. "Effect of prolonged therapeutic hypothermia on intracranial pressure, organ function, and hospital outcomes among patients with aneurysmal subarachnoid hemorrhage." Neurocritical care 21.3 (2014): 451-461.
Kim, Jong Youl, and Midori A. Yenari. "Hypothermia for treatment of stroke." Brain Circulation 1.1 (2015): 14.
Todd MM, Hindman BJ, Clarke WR, Torner JC; Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) Investigators. Mild intraoperative hypothermia during surgery for intracranial aneurysm. N Engl J Med 2005;352:135-45.
Clark, Darren L., et al. "Comparison of 12, 24 and 48 h of systemic hypothermia on outcome after permanent focal ischemia in rat." Experimental neurology 212.2 (2008): 386-392.
Shankaran, Seetha, et al. "Whole-body hypothermia for neonates with hypoxic–ischemic encephalopathy." New England Journal of Medicine 353.15 (2005): 1574-1584.
Shankaran, Seetha, et al. "Childhood outcomes after hypothermia for neonatal encephalopathy." New England Journal of Medicine 366.22 (2012): 2085-2092.
Azzopardi, Denis, et al. "Effects of hypothermia for perinatal asphyxia on childhood outcomes." New England Journal of Medicine 371.2 (2014): 140-149.
Mourvillier, Bruno, et al. "Induced hypothermia in severe bacterial meningitis: a randomized clinical trial." JAMA 310.20 (2013): 2174-2183.
Rim, Kwang Pil, et al. "Effect of therapeutic hypothermia according to severity of sepsis in a septic rat model." Cytokine 60.3 (2012): 755-761.
Corry, Jesse J., et al. "Hypothermia for refractory status epilepticus." Neurocritical care 9.2 (2008): 189-197.
Villar, Jesus, and Arthur S. Slutsky. "Effects of induced hypothermia in patients with septic adult respiratory distress syndrome." Resuscitation 26.2 (1993): 183-192.
White, H. D., C. D. Spradley, and A. Hayek. "Therapeutic Hypothermia For Refractory Hypoxia In Acute Respiratory Distress Syndrome Undergoing Extracorporeal Membrane Oxygenation." Am J Respir Crit Care Med 191 (2015): A4570.
Zhicheng, Fang, et al. "Effect of mild hypothermia treatment on mechanical ventilation of acute respiratory distress syndrome." Modern Journal of Integrated Traditional Chinese and Western Medicine 29 (2012): 002.
Stravitz, R. Todd, et al. "Therapeutic hypothermia for acute liver failure: toward a randomized, controlled trial in patients with advanced hepatic encephalopathy." Neurocritical care 9.1 (2008): 90-96.
Jalan, Rajiv, et al. "Moderate hypothermia for uncontrolled intracranial hypertension in acute liver failure." The Lancet 354.9185 (1999): 1164-1168.
Karvellas, C., et al. "A multicenter retrospective cohort analysis of therapeutic hypothermia in acute liver failure." Critical Care 18.Suppl 1 (2014): P200.
Wu, Xianren, et al. "Induction of profound hypothermia for emergency preservation and resuscitation allows intact survival after cardiac arrest resulting from prolonged lethal hemorrhage and trauma in dogs." Circulation 113.16 (2006): 1974-1982.
Legriel, Stephane, et al. "Hypothermia for neuroprotection in convulsive status epilepticus." New England Journal of Medicine 375.25 (2016): 2457-2467.