THERAPEUTIC HYPOTHERMIA AND TEMPERATURE MANAGEMENT Volume 4, Number 4, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/ther.2014.1513
Editorial
Editorial W. Dalton Dietrich, PhD
T
he current issue of Therapeutic Hypothermia and Temperature Management has a variety of scientific reports that will be of special interest to our readers. Two expert panel discussions/roundtables that were held at a March 2014 scientific symposium in Miami, Florida, summarize recent concepts and gaps in knowledge regarding the use of temperature management in several patient populations. One discussion focuses on recent work in the field of critical care medicine and novel strategies to reduce the consequences of post–cardiac arrest syndrome. A combination approach including state-of-the art critical care protocols as well as therapeutic hypothermia, fluid balance, hemodynamic optimization, and other approaches is highlighted. A second roundtable discussion specifically focuses on the area of cardiac arrest and optimal temperature management. Recent interest in a large multicenter clinical trial that compared 33C versus 36C after cardiac arrest conducted in Europe and Australia is highlighted. It is clear from these thoughtful discussions that more work is required in this emerging clinical treatment area with various knowledge gaps remaining. A review article on the effects of therapeutic hypothermia in the setting of experimental acute myocardial infarction is presented by Dr. Herring and colleagues. Past and current methods of inducing hypothermia, benefits and set-backs of such methods, as well as future clinical trials are highlighted. Dr. Heidlebaugh and colleagues present an original article describing full neurological recovery and return of spontaneous recirculation with hypothermia in a patient who arrested while undergoing elective coronary angioplasty. Another article by Dr. Iwata and colleagues reviews the evidence for cooling in babies in neonatal critical care units. Also, included is a study by Dr. Wowk and colleagues emphasizing in an experimental model that mild therapeutic hypothermia does not reduce thrombin-induced brain injury. This observation may partially explain why cooling is often not robustly neuroprotective in preclinical models of intracerebral hemorrhage. Dr. Mazer-Amirshahi and colleagues provide interesting data to support the potential need for
magnesium supplementation in comatose patients with post– cardiac arrest syndrome that undergo therapeutic hypothermia. Finally, Dr. Laptook and colleagues explain the use of a next-generation surface cooling device to achieve therapeutic hypothermia in infants with newborn encephalopathy of a hypoxic-ischemic origin. Continued research is required to maximize cooling strategies that most benefit individual patient populations. The special Q & A section, The Arctic Challenge, again addresses several important questions regarding the use and potential risk factors associated with therapeutic hypothermia. One question relates to the generation of seizure activity and epileptiform discharges in patients where therapeutic hypothermia is being utilized. The use or nonuse of paralytics during hypothermia induction and rewarming phase within the operating room and alternative strategies to target shivering are also emphasized in another segment. Another important question pertains to whether or not to continue to cool a patient with a known source of infection. Finally, the need and potentially beneficial effects of aggressive fever management in a coiled patient after a cerebral artery aneurism are discussed. Together, these questions and answers by experts provide insightful information with appropriate literature citations regarding the current knowledge for the clinical use of therapeutic hypothermia and temperature management. In my role as editor-in-chief, I hope you are enjoying the Journal. If you have any questions or would like to submit a letter to the editor specifically addressing points made in our articles, please contact me at [email protected]. I look forward to your continued participation in the growth of our Journal. I thank all the authors who are submitting interesting articles and our outstanding reviewers who together are helping to make this an important conduit for communicating the most recent findings to our international audience.
149
—W. Dalton Dietrich, PhD Editor-in-Chief
Editorial
Editorial W. Dalton Dietrich, PhD
T
he current issue of Therapeutic Hypothermia and Temperature Management has a variety of scientific reports that will be of special interest to our readers. Two expert panel discussions/roundtables that were held at a March 2014 scientific symposium in Miami, Florida, summarize recent concepts and gaps in knowledge regarding the use of temperature management in several patient populations. One discussion focuses on recent work in the field of critical care medicine and novel strategies to reduce the consequences of post–cardiac arrest syndrome. A combination approach including state-of-the art critical care protocols as well as therapeutic hypothermia, fluid balance, hemodynamic optimization, and other approaches is highlighted. A second roundtable discussion specifically focuses on the area of cardiac arrest and optimal temperature management. Recent interest in a large multicenter clinical trial that compared 33C versus 36C after cardiac arrest conducted in Europe and Australia is highlighted. It is clear from these thoughtful discussions that more work is required in this emerging clinical treatment area with various knowledge gaps remaining. A review article on the effects of therapeutic hypothermia in the setting of experimental acute myocardial infarction is presented by Dr. Herring and colleagues. Past and current methods of inducing hypothermia, benefits and set-backs of such methods, as well as future clinical trials are highlighted. Dr. Heidlebaugh and colleagues present an original article describing full neurological recovery and return of spontaneous recirculation with hypothermia in a patient who arrested while undergoing elective coronary angioplasty. Another article by Dr. Iwata and colleagues reviews the evidence for cooling in babies in neonatal critical care units. Also, included is a study by Dr. Wowk and colleagues emphasizing in an experimental model that mild therapeutic hypothermia does not reduce thrombin-induced brain injury. This observation may partially explain why cooling is often not robustly neuroprotective in preclinical models of intracerebral hemorrhage. Dr. Mazer-Amirshahi and colleagues provide interesting data to support the potential need for
magnesium supplementation in comatose patients with post– cardiac arrest syndrome that undergo therapeutic hypothermia. Finally, Dr. Laptook and colleagues explain the use of a next-generation surface cooling device to achieve therapeutic hypothermia in infants with newborn encephalopathy of a hypoxic-ischemic origin. Continued research is required to maximize cooling strategies that most benefit individual patient populations. The special Q & A section, The Arctic Challenge, again addresses several important questions regarding the use and potential risk factors associated with therapeutic hypothermia. One question relates to the generation of seizure activity and epileptiform discharges in patients where therapeutic hypothermia is being utilized. The use or nonuse of paralytics during hypothermia induction and rewarming phase within the operating room and alternative strategies to target shivering are also emphasized in another segment. Another important question pertains to whether or not to continue to cool a patient with a known source of infection. Finally, the need and potentially beneficial effects of aggressive fever management in a coiled patient after a cerebral artery aneurism are discussed. Together, these questions and answers by experts provide insightful information with appropriate literature citations regarding the current knowledge for the clinical use of therapeutic hypothermia and temperature management. In my role as editor-in-chief, I hope you are enjoying the Journal. If you have any questions or would like to submit a letter to the editor specifically addressing points made in our articles, please contact me at [email protected]. I look forward to your continued participation in the growth of our Journal. I thank all the authors who are submitting interesting articles and our outstanding reviewers who together are helping to make this an important conduit for communicating the most recent findings to our international audience.
149
—W. Dalton Dietrich, PhD Editor-in-Chief
