Rapid and selective cerebral hypothermia achieved using a cooling helmet

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Object

Hypothermia is by far the most potent neuroprotectant. Nevertheless, timely and safe delivery of hypothermia remains a clinical challenge. To maximize neuroprotection yet minimize systemic complications, ultra-early delivery of selective cerebral hypothermia by Emergency Medical Service (EMS) personnel in the field would be advantageous. The authors (W.E. and H.W.) have developed a cooling helmet by using National Aeronautics and Space Administration spinoff technology. In this study its effectiveness in lowering brain temperature in patients with severe stroke or head injury is examined.

Methods

Patients were randomly assigned to groups receiving either the cooling helmet or no cooling, and brain temperatures (0.8 cm below the cortical surface) were continuously monitored for a mean of 48 to 72 hours with a Neurotrend sensor and then compared with the patients' core temperatures. There were eight patients in the study group and six in the control group. The mean change in temperature (brain — body temperature) calculated from 277 data hours in the study group was − 1.6°C compared with a mean change in temperature of + 0.22°C calculated from 309 data hours in the control group. This was statistically significant (p < 0.0001). On average, 1.84°C of brain temperature reduction (range 0.9–2.4°C) was observed within 1 hour of helmet application. It took a mean of 3.4 hours (range 2–6 hours) to achieve a brain temperature lower than 34°C and 6.67 hours (range 1–12 hours) before systemic hypothermia (< 36°C) occurred. Use of the helmet resulted in no significant complications. There was, however, one episode of asymptomatic bradycardia (heart rate < 40) that responded to a 0.5°C body temperature increase.

Conclusions

This helmet delivers initial rapid and selective brain cooling and maintains a significant temperature gradient between the core and brain temperatures throughout the hypothermic period to provide sufficient regional hypothermia yet minimize systemic complications. It results in delayed systemic hypothermia, creating a safe window for possible ultra-early delivery of regional hypothermia by EMS personnel in the field.

Article Information

Address reprint requests to: William C. Olivero, M.D., Department of Neurosurgery, University of Illinois College of Medicine at Peoria, P.O. Box 1649, Peoria, Illinois 61656. email: olib@uic.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Photograph showing the helmet worn by William Elkins, a NASA scientist, who invented this technology. The cooling helmet has an outer pneumatic liner pressurized to allow close contact with the cranium and neck. The device also is adjustable to fit a significant range of head sizes.

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    Graph showing that, within 15 minutes after application of the cooling helmet, the brain temperature dropped by approximately 2°C, whereas the core temperature did not drop below 37°C until 4 to 5 hours later. The cooling helmet maintained brain temperature at approximately 1.5 to 2.5°C below core temperature throughout the 48-hour cooling period. When the core temperature dropped to 32°C and brain temperature dropped to 29.4°C, active body warming was initiated to minimize the risk of cardiac arrhythmia. After the cooling helmet was removed at Hour 48, the brain temperature approached the core temperature within 1 to 2 hours, and then both rose gradually to 37°C over a 30-hour period. B-temp = brain temperature; C-temp = core temperature.

References

  • 1.

    Almond CHJones JCSnyder HMet al: Cooling gradients and brain damage with deep hypothermia. J Thorac Cardiovasc Surg 48:8908971964Almond CH Jones JC Snyder HM et al: Cooling gradients and brain damage with deep hypothermia. J Thorac Cardiovasc Surg 48:890–897 1964

    • Search Google Scholar
    • Export Citation
  • 2.

    Barone FFeuerstein GZWhite RF: Brain cooling during transient focal ischemia provides complete neuroprotection. Neurosci Biobehav Rev 21:31441996Barone F Feuerstein GZ White RF: Brain cooling during transient focal ischemia provides complete neuroprotection. Neurosci Biobehav Rev 21:31–44 1996

    • Search Google Scholar
    • Export Citation
  • 3.

    Bernard SAGray TWBuist MDet al: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:5575632002Bernard SA Gray TW Buist MD et al: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346:557–563 2002

    • Search Google Scholar
    • Export Citation
  • 4.

    Busto RDietrich WDGlobus MYTet al: The importance of brain temperature in cerebral ischemic injury. Stroke 20:111311141989Busto R Dietrich WD Globus MYT et al: The importance of brain temperature in cerebral ischemic injury. Stroke 20:1113–1114 1989

    • Search Google Scholar
    • Export Citation
  • 5.

    Busto RGinsberg MD: The influence of altered brain temperature in cerebral ischemia in Ginsberg MDBogousslavsky J (eds): Cerebrovascular Disease: Pathophysiology Diagnosis and Management. Malden, MA: Blackwell Science1998 pp 287307Busto R Ginsberg MD: The influence of altered brain temperature in cerebral ischemia in Ginsberg MD Bogousslavsky J (eds): Cerebrovascular Disease: Pathophysiology Diagnosis and Management. Malden MA: Blackwell Science 1998 pp 287–307

    • Search Google Scholar
    • Export Citation
  • 6.

    Carroll MBeek O: Protection against hippocampal CA1 cell loss by post-ischemic hypothermia is dependent on delay of initiation and duration. Metab Brain Dis 7:45501992Carroll M Beek O: Protection against hippocampal CA1 cell loss by post-ischemic hypothermia is dependent on delay of initiation and duration. Metab Brain Dis 7:45–50 1992

    • Search Google Scholar
    • Export Citation
  • 7.

    Chater NAAdams JELeake TBet al: Cardiovascular effects of local brain stem cooling. Surg Forum 11:4084101960Chater NA Adams JE Leake TB et al: Cardiovascular effects of local brain stem cooling. Surg Forum 11:408–410 1960

    • Search Google Scholar
    • Export Citation
  • 8.

    Clifton GLAllen SBerry Jet al: Systemic hypothermia in treatment of brain injury. J Neurotrauma 9 (Suppl 2):S487S4951992Clifton GL Allen S Berry J et al: Systemic hypothermia in treatment of brain injury. J Neurotrauma 9 (Suppl 2):S487–S495 1992

    • Search Google Scholar
    • Export Citation
  • 9.

    Clifton GLMiller ERChoi SCet al: Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 344:5565632001Clifton GL Miller ER Choi SC et al: Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 344:556–563 2001

    • Search Google Scholar
    • Export Citation
  • 10.

    Coimbra CWieloch T: Moderate hypothermia mitigates neuronal damage in the rat brain when initiated several hours following transient cerebral ischemia. Acta Neuropathol 87:3253311994Coimbra C Wieloch T: Moderate hypothermia mitigates neuronal damage in the rat brain when initiated several hours following transient cerebral ischemia. Acta Neuropathol 87:325–331 1994

    • Search Google Scholar
    • Export Citation
  • 11.

    Colbourne FCorbett D: Delayed and prolonged post-ischemic hypothermia is neuroprotective in the gerbil. Brain Res 654:2652721994Colbourne F Corbett D: Delayed and prolonged post-ischemic hypothermia is neuroprotective in the gerbil. Brain Res 654:265–272 1994

    • Search Google Scholar
    • Export Citation
  • 12.

    Colbourne FCorbett D: Delayed postischemic hypothermia: a six month survival study using behavioral and histologic assessments of neuroprotection. J Neurosci 15:725072601995Colbourne F Corbett D: Delayed postischemic hypothermia: a six month survival study using behavioral and histologic assessments of neuroprotection. J Neurosci 15:7250–7260 1995

    • Search Google Scholar
    • Export Citation
  • 13.

    Colbourne FLi HBuchan AM: Indefatigable CA1 sector neuroprotection with mild hypothermia induced 6 hours after severe forebrain ischemia in rats. J Cereb Blood Flow Metab 19:7427491999Colbourne F Li H Buchan AM: Indefatigable CA1 sector neuroprotection with mild hypothermia induced 6 hours after severe forebrain ischemia in rats. J Cereb Blood Flow Metab 19:742–749 1999

    • Search Google Scholar
    • Export Citation
  • 14.

    Corbett DHamilton MColbourne F: Persistent neuroprotection with prolonged postischemic hypothermia in adult rats subjected to transient middle cerebral artery occlusion. Exp Neurol 163:2002062000Corbett D Hamilton M Colbourne F: Persistent neuroprotection with prolonged postischemic hypothermia in adult rats subjected to transient middle cerebral artery occlusion. Exp Neurol 163:200–206 2000

    • Search Google Scholar
    • Export Citation
  • 15.

    Costal MOwens GWoldring S: Experimental production of cerebral hypothermia by ventricular perfusion techniques. J Neurosurg 20:1121171963Costal M Owens G Woldring S: Experimental production of cerebral hypothermia by ventricular perfusion techniques. J Neurosurg 20:112–117 1963

    • Search Google Scholar
    • Export Citation
  • 16.

    Dietrich WDBusto RAlonso Oet al: Intraischemic but not postischemic brain hypothermia protects chronically following global forebrain ischemia in rats. J Cereb Blood Flow Metab 13:5415491993Dietrich WD Busto R Alonso O et al: Intraischemic but not postischemic brain hypothermia protects chronically following global forebrain ischemia in rats. J Cereb Blood Flow Metab 13:541–549 1993

    • Search Google Scholar
    • Export Citation
  • 17.

    Dietrich WDBusto RGlobus MYTet al: Brain damage and temperature: cellular and molecular mechanisms in Siesjo BKWieloch T (eds): Cellular and Molecular Mechanisms of Ischemic Brain Damage. Philadelphia: Lippincott-Raven1996 pp 177197Dietrich WD Busto R Globus MYT et al: Brain damage and temperature: cellular and molecular mechanisms in Siesjo BK Wieloch T (eds): Cellular and Molecular Mechanisms of Ischemic Brain Damage. Philadelphia: Lippincott-Raven 1996 pp 177–197

    • Search Google Scholar
    • Export Citation
  • 18.

    Du Boulay GHLawton MWallis A: The story of the internal carotid artery of mammals: from Galen to sudden infant death syndrome. Neuroradiology 40:6977031998Du Boulay GH Lawton M Wallis A: The story of the internal carotid artery of mammals: from Galen to sudden infant death syndrome. Neuroradiology 40:697–703 1998

    • Search Google Scholar
    • Export Citation
  • 19.

    Eisenburger PSafar P: Life supporting first aid training of the public—review and recommendations. Resuscitation 41:3181999Eisenburger P Safar P: Life supporting first aid training of the public—review and recommendations. Resuscitation 41:3–18 1999

    • Search Google Scholar
    • Export Citation
  • 20.

    Frank SMFleisher LABreslow MJet al: Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 277:112711341997Frank SM Fleisher LA Breslow MJ et al: Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 277:1127–1134 1997

    • Search Google Scholar
    • Export Citation
  • 21.

    Garcia JH: The evolution of brain infarcts. A review. J Neuropathol Exp Neurol 51:3873931992Garcia JH: The evolution of brain infarcts. A review. J Neuropathol Exp Neurol 51:387–393 1992

    • Search Google Scholar
    • Export Citation
  • 22.

    Garcia JHLiu KFHo KL: Neuronal necrosis after middle cerebral artery occlusion in Wistar rats progresses at different time intervals in the caudoputamen and the cortex. Stroke 26:6366431995Garcia JH Liu KF Ho KL: Neuronal necrosis after middle cerebral artery occlusion in Wistar rats progresses at different time intervals in the caudoputamen and the cortex. Stroke 26:636–643 1995

    • Search Google Scholar
    • Export Citation
  • 23.

    Gelman BSchleien CLLohe Aet al: Selective brain cooling in infant piglets after cardiac arrest and resuscitation. Crit Care Med 24:100910171996Gelman B Schleien CL Lohe A et al: Selective brain cooling in infant piglets after cardiac arrest and resuscitation. Crit Care Med 24:1009–1017 1996

    • Search Google Scholar
    • Export Citation
  • 24.

    Ginsberg MD: The concept of the therapeutic window: a synthesis of critical issues in Moskowitz MACaplan LR (eds): Cerebrovascular Diseases: Nineteenth Princeton Stroke Conference. Boston: Butterworth-Heinemann1995 pp 331351Ginsberg MD: The concept of the therapeutic window: a synthesis of critical issues in Moskowitz MA Caplan LR (eds): Cerebrovascular Diseases: Nineteenth Princeton Stroke Conference. Boston: Butterworth-Heinemann 1995 pp 331–351

    • Search Google Scholar
    • Export Citation
  • 25.

    Ginsberg MDSternau LLGlobus MYTet al: Therapeutic modulation of brain temperature: relevance to ischemic brain injury. Cerebrovasc Brain Metab Rev 4:1892251992Ginsberg MD Sternau LL Globus MYT et al: Therapeutic modulation of brain temperature: relevance to ischemic brain injury. Cerebrovasc Brain Metab Rev 4:189–225 1992

    • Search Google Scholar
    • Export Citation
  • 26.

    Gunn AJGunn TRde Haan HHet al: Dramatic neuronal rescue with prolonged selective head cooling after ischemia in fetal lambs. J Clin Invest 99:2482561997Gunn AJ Gunn TR de Haan HH et al: Dramatic neuronal rescue with prolonged selective head cooling after ischemia in fetal lambs. J Clin Invest 99:248–256 1997

    • Search Google Scholar
    • Export Citation
  • 27.

    Haaland KSteen PAThoresen M: Cerebral, tympanic and colonic thermometry in the piglet. Reprod Fertil Dev 8:1251281996Haaland K Steen PA Thoresen M: Cerebral tympanic and colonic thermometry in the piglet. Reprod Fertil Dev 8:125–128 1996

    • Search Google Scholar
    • Export Citation
  • 28.

    Hiyashi NHirayama TOhata M: The computed cerebral hypothermia management technique to the critical head injury patients. Adv Neurotrauma Res 5:61641993Hiyashi N Hirayama T Ohata M: The computed cerebral hypothermia management technique to the critical head injury patients. Adv Neurotrauma Res 5:61–64 1993

    • Search Google Scholar
    • Export Citation
  • 29.

    Horn MSchlote WHenrich HA: Global cerebral ischemia and subsequent selective hypothermia. A neuropathological and morphometrical study on ischemic neuronal damage in cat. Acta Neuropathol 81:4434491991Horn M Schlote W Henrich HA: Global cerebral ischemia and subsequent selective hypothermia. A neuropathological and morphometrical study on ischemic neuronal damage in cat. Acta Neuropathol 81:443–449 1991

    • Search Google Scholar
    • Export Citation
  • 30.

    Huh PWBelayev LZhao Wet al: Comparative neuroprotective efficacy of prolonged moderate intraischemic and postischemic hypothermia in focal cerebral ischemia. J Neurosurg 92:91992000Huh PW Belayev L Zhao W et al: Comparative neuroprotective efficacy of prolonged moderate intraischemic and postischemic hypothermia in focal cerebral ischemia. J Neurosurg 92:91–99 2000

    • Search Google Scholar
    • Export Citation
  • 31.

    The Hypothermia After Cardiac Arrest Study Group: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:5495562002The Hypothermia After Cardiac Arrest Study Group: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556 2002

    • Search Google Scholar
    • Export Citation
  • 32.

    Kissen ATHall JF JrKlemm FK: Physiological responses to cooling the head and neck versus the trunk and leg areas in severe hyperthermic exposure. Aerosp Med 42:8828881971Kissen AT Hall JF Jr Klemm FK: Physiological responses to cooling the head and neck versus the trunk and leg areas in severe hyperthermic exposure. Aerosp Med 42:882–888 1971

    • Search Google Scholar
    • Export Citation
  • 33.

    Krieger DWDe Georgia MADevlin Tet al: Cooling acute ischemic brain damage (cool aid): a randomized pilot trial of endovascular cooling for patients with acute ischemic stroke. Stroke 34:2482003 (Abstract)Krieger DW De Georgia MA Devlin T et al: Cooling acute ischemic brain damage (cool aid): a randomized pilot trial of endovascular cooling for patients with acute ischemic stroke. Stroke 34:248 2003 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 34.

    Kuhnen GBauer RWalter B: Controlled brain hypothermia by extracorporeal carotid blood cooling at normothermic trunk temperatures in pigs. J Neurosci Methods 89:1671741999Kuhnen G Bauer R Walter B: Controlled brain hypothermia by extracorporeal carotid blood cooling at normothermic trunk temperatures in pigs. J Neurosci Methods 89:167–174 1999

    • Search Google Scholar
    • Export Citation
  • 35.

    Kuluz JWGregory GAYu ACHet al: Selective brain cooling during and after prolonged global ischemia reduces cortical damage in rats. Stroke 23:179217971992Kuluz JW Gregory GA Yu ACH et al: Selective brain cooling during and after prolonged global ischemia reduces cortical damage in rats. Stroke 23:1792–1797 1992

    • Search Google Scholar
    • Export Citation
  • 36.

    Kuluz JWPrado RChang Jet al: Selective brain cooling increases cortical cerebral blood flow in rats. Am J Physiol 265:H824H8271993Kuluz JW Prado R Chang J et al: Selective brain cooling increases cortical cerebral blood flow in rats. Am J Physiol 265:H824–H827 1993

    • Search Google Scholar
    • Export Citation
  • 37.

    Kurz ASessler DILenhardt R: Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 334:120912151996Kurz A Sessler DI Lenhardt R: Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 334:1209–1215 1996

    • Search Google Scholar
    • Export Citation
  • 38.

    Langer TNielsen BJessen C: Non-thermometric means of assessing cooling in humans in Milton AS (ed): Temperature Regulation: Recent Physiological and Pharmacological Advances. Basel: Birkhaeuser Verlag1994 pp 145149Langer T Nielsen B Jessen C: Non-thermometric means of assessing cooling in humans in Milton AS (ed): Temperature Regulation: Recent Physiological and Pharmacological Advances. Basel: Birkhaeuser Verlag 1994 pp 145–149

    • Search Google Scholar
    • Export Citation
  • 39.

    Laptook ARShalak LCorbett RJT: Differences in brain temperature and cerebral blood flow during selective head versus wholebody cooling. Pediatrics 108:110311102001Laptook AR Shalak L Corbett RJT: Differences in brain temperature and cerebral blood flow during selective head versus wholebody cooling. Pediatrics 108:1103–1110 2001

    • Search Google Scholar
    • Export Citation
  • 40.

    Leonov YSterz FSafar Pet al: Mild hypothermia during and after cardiac arrest improves neurologic outcome in dogs. J Cereb Blood Flow Metab 10:57701990Leonov Y Sterz F Safar P et al: Mild hypothermia during and after cardiac arrest improves neurologic outcome in dogs. J Cereb Blood Flow Metab 10:57–70 1990

    • Search Google Scholar
    • Export Citation
  • 41.

    Lyden PNg KAl-Senani Fet al: Phase 1 study of endovascular-induced hypothermia in patients with acute ischemic stroke. Stroke 34:2492003 (Abstract)Lyden P Ng K Al-Senani F et al: Phase 1 study of endovascular-induced hypothermia in patients with acute ischemic stroke. Stroke 34:249 2003 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 42.

    Maher JHachinski V: Hypothermia as a potential treatment for cerebral ischemia. Cerebrovasc Brain Metab Rev 5:2773001993Maher J Hachinski V: Hypothermia as a potential treatment for cerebral ischemia. Cerebrovasc Brain Metab Rev 5:277–300 1993

    • Search Google Scholar
    • Export Citation
  • 43.

    Maier CMSun GHKunis Det al: Delayed induction and longterm effects of mild hypothermia in a focal model of transient cerebral ischemia: neurological outcome and infarct size. J Neurosurg 94:90962001Maier CM Sun GH Kunis D et al: Delayed induction and longterm effects of mild hypothermia in a focal model of transient cerebral ischemia: neurological outcome and infarct size. J Neurosurg 94:90–96 2001

    • Search Google Scholar
    • Export Citation
  • 44.

    Marion DW: Cytokines and therapeutic hypothermia. Crit Care Med 30:166616672002 (Editorial)Marion DW: Cytokines and therapeutic hypothermia. Crit Care Med 30:1666–1667 2002 (Editorial)

    • Search Google Scholar
    • Export Citation
  • 45.

    Marion DWPenrod LEKelsey SFet al: Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med 336:5405461997Marion DW Penrod LE Kelsey SF et al: Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med 336:540–546 1997

    • Search Google Scholar
    • Export Citation
  • 46.

    Markgraf CGClifton GLMoody MR: Treatment window for hypothermia in brain injury. J Neurosurg 95:9799832001Markgraf CG Clifton GL Moody MR: Treatment window for hypothermia in brain injury. J Neurosurg 95:979–983 2001

    • Search Google Scholar
    • Export Citation
  • 47.

    Mellergard P: Changes in human intracerebral temperature in response to different methods of brain cooling. Neurosurgery 31:6716771992Mellergard P: Changes in human intracerebral temperature in response to different methods of brain cooling. Neurosurgery 31:671–677 1992

    • Search Google Scholar
    • Export Citation
  • 48.

    Mellergard PNordstrom CH: Intracerebral temperature in neurosurgical patients. Neurosurgery 28:7097131991Mellergard P Nordstrom CH: Intracerebral temperature in neurosurgical patients. Neurosurgery 28:709–713 1991

    • Search Google Scholar
    • Export Citation
  • 49.

    Natale JED'Alecy LG: Protection from cerebral ischemia by brain cooling without reduced lactate accumulation in dogs. Stroke 20:7707771989Natale JE D'Alecy LG: Protection from cerebral ischemia by brain cooling without reduced lactate accumulation in dogs. Stroke 20:770–777 1989

    • Search Google Scholar
    • Export Citation
  • 50.

    Negrin J Jr: Selective local hypothermia in neurosurgery. NY State J Med 61:295129651961Negrin J Jr: Selective local hypothermia in neurosurgery. NY State J Med 61:2951–2965 1961

    • Search Google Scholar
    • Export Citation
  • 51.

    Nunneley DATroutman SJ JrWebb P: Head cooling in work and heat stress. Aerosp Med 42:64681971Nunneley DA Troutman SJ Jr Webb P: Head cooling in work and heat stress. Aerosp Med 42:64–68 1971

    • Search Google Scholar
    • Export Citation
  • 52.

    Obrenovitch TP: The ischaemic penumbra: twenty years on. Cerebrovasc Brain Metab Rev 7:2973231995Obrenovitch TP: The ischaemic penumbra: twenty years on. Cerebrovasc Brain Metab Rev 7:297–323 1995

    • Search Google Scholar
    • Export Citation
  • 53.

    Ohta TKuroiwa TSakaguchi Iet al: Selective hypothermic perfusion of canine brain. Neurosurgery 38:121112151996Ohta T Kuroiwa T Sakaguchi I et al: Selective hypothermic perfusion of canine brain. Neurosurgery 38:1211–1215 1996

    • Search Google Scholar
    • Export Citation
  • 54.

    Ommaya AKBaldwin M: Direct extravascular brain cooling in the normothermic animal. Neurology 12:8828951962Ommaya AK Baldwin M: Direct extravascular brain cooling in the normothermic animal. Neurology 12:882–895 1962

    • Search Google Scholar
    • Export Citation
  • 55.

    Rumana CSGopinath SPUzura Met al: Brain temperature exceeds systemic temperature in head-injured patients. Crit Care Med 26:5625671998Rumana CS Gopinath SP Uzura M et al: Brain temperature exceeds systemic temperature in head-injured patients. Crit Care Med 26:562–567 1998

    • Search Google Scholar
    • Export Citation
  • 56.

    Safar P: Resuscitation of the ischemic brain in Albin MS (ed): Textbook of Neuroanesthesia: With Neurosurgical and Neuroscience Perspectives. New York: McGraw-Hill1997 pp 557593Safar P: Resuscitation of the ischemic brain in Albin MS (ed): Textbook of Neuroanesthesia: With Neurosurgical and Neuroscience Perspectives. New York: McGraw-Hill 1997 pp 557–593

    • Search Google Scholar
    • Export Citation
  • 57.

    Schmied HKurz ASessler DIet al: Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 347:2892921996Schmied H Kurz A Sessler DI et al: Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 347:289–292 1996

    • Search Google Scholar
    • Export Citation
  • 58.

    Schwab SSchwarz SAschoff Aet al: Moderate hypothermia and brain temperature in patients with severe middle cerebral artery infarction. Acta Neurochir Suppl 71:1311341998Schwab S Schwarz S Aschoff A et al: Moderate hypothermia and brain temperature in patients with severe middle cerebral artery infarction. Acta Neurochir Suppl 71:131–134 1998

    • Search Google Scholar
    • Export Citation
  • 59.

    Schwab SSpranger MAschoff Aet al: Brain temperature monitoring and modulation in patients with severe MCA infarction. Neurology 48:7627671997Schwab S Spranger M Aschoff A et al: Brain temperature monitoring and modulation in patients with severe MCA infarction. Neurology 48:762–767 1997

    • Search Google Scholar
    • Export Citation
  • 60.

    Senning AOlsson PI: Changes in the vascular tonus during cerebral and regional hypothermia. Acta Chir Scand 112:2092191957Senning A Olsson PI: Changes in the vascular tonus during cerebral and regional hypothermia. Acta Chir Scand 112:209–219 1957

    • Search Google Scholar
    • Export Citation
  • 61.

    Shvartz E: Effect of a cooling hood on physiological responses to work in a hot environment. J Appl Physiol 29:36391970Shvartz E: Effect of a cooling hood on physiological responses to work in a hot environment. J Appl Physiol 29:36–39 1970

    • Search Google Scholar
    • Export Citation
  • 62.

    Sirimanne ESBlumberg RMBossano Det al: The effect of prolonged modification of cerebral temperature on outcome after hypoxic-ischemic brain injury in the infant rat. Pediatr Res 39:5915971996Sirimanne ES Blumberg RM Bossano D et al: The effect of prolonged modification of cerebral temperature on outcome after hypoxic-ischemic brain injury in the infant rat. Pediatr Res 39:591–597 1996

    • Search Google Scholar
    • Export Citation
  • 63.

    Sternau LThompson CDietrich WDet al: Intracranial temperature: observations in the human brain. J Cereb Blood Flow Metab 11 (Suppl 2):S1231991 (Abstract)Sternau L Thompson C Dietrich WD et al: Intracranial temperature: observations in the human brain. J Cereb Blood Flow Metab 11 (Suppl 2):S123 1991 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 64.

    Tadler SCCallaway CWMenegazzi JJ: Noninvasive cerebral cooling in a swine model of cardiac arrest. Acad Emerg Med 5:25301998Tadler SC Callaway CW Menegazzi JJ: Noninvasive cerebral cooling in a swine model of cardiac arrest. Acad Emerg Med 5:25–30 1998

    • Search Google Scholar
    • Export Citation
  • 65.

    Takeda YNamba KHiguchi Tet al: Quantitative evaluation of the neuroprotective effects of hypothermia ranging from 34°C to 31°C on brain ischemia in gerbils and determination of the mechanism of neuroprotection. Crit Care Med 31:2552602003Takeda Y Namba K Higuchi T et al: Quantitative evaluation of the neuroprotective effects of hypothermia ranging from 34°C to 31°C on brain ischemia in gerbils and determination of the mechanism of neuroprotection. Crit Care Med 31:255–260 2003

    • Search Google Scholar
    • Export Citation
  • 66.

    Thoresen MSimmonds MSatas Set al: Effective selective head cooling during posthypoxic hypothermia in newborn piglets. Pediatr Res 49:5945992001Thoresen M Simmonds M Satas S et al: Effective selective head cooling during posthypoxic hypothermia in newborn piglets. Pediatr Res 49:594–599 2001

    • Search Google Scholar
    • Export Citation
  • 67.

    Wass CTWaggoner JR IIICable DGet al: Selective convective brain cooling during hypothermic cardiopulmonary bypass in dogs. Ann Thorac Surg 66:200820141998Wass CT Waggoner JR III Cable DG et al: Selective convective brain cooling during hypothermic cardiopulmonary bypass in dogs. Ann Thorac Surg 66:2008–2014 1998

    • Search Google Scholar
    • Export Citation
  • 68.

    Welsh FASims REHarris VA: Mild hypothermia prevents ischemic injury in gerbil hippocampus. J Cereb Blood Flow Metab 10:5575631990Welsh FA Sims RE Harris VA: Mild hypothermia prevents ischemic injury in gerbil hippocampus. J Cereb Blood Flow Metab 10:557–563 1990

    • Search Google Scholar
    • Export Citation
  • 69.

    White RJLocke GEAlbin MS: Isolated profound cerebral cooling with a bi-carotid heat exchanger shunt in dogs. Resuscitation 10:1931951983White RJ Locke GE Albin MS: Isolated profound cerebral cooling with a bi-carotid heat exchanger shunt in dogs. Resuscitation 10:193–195 1983

    • Search Google Scholar
    • Export Citation
  • 70.

    Williams BAShitzer A: Modular liquid cooled helmet liner for thermal comfort. Aerospace Med 45:103010361974Williams BA Shitzer A: Modular liquid cooled helmet liner for thermal comfort. Aerospace Med 45:1030–1036 1974

    • Search Google Scholar
    • Export Citation
  • 71.

    Zhu LDiao C: Theoretical simulation of temperature distribution in the brain during mild hypothermia treatment for brain injury. Med Biol Eng Comput 39:6816872001Zhu L Diao C: Theoretical simulation of temperature distribution in the brain during mild hypothermia treatment for brain injury. Med Biol Eng Comput 39:681–687 2001

    • Search Google Scholar
    • Export Citation

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