Deep and profound hypothermia in haemorrhagic shock, friend or foe? A systematic review

Journal of the Royal Army Medical Corps
Samuel E MoffattJ L Walke

Abstract

Survival in exsanguinating cardiac arrest patients is poor, as is neurological outcome in survivors. Hypothermia has traditionally been seen as harmful to trauma patients and associated with increased mortality; however, there has been speculation that cooling to very low temperatures (≤20°C) could be used to treat haemorrhagic trauma patients by the induction of a suspended animation period through extreme cooling, which improves survival and preserves neurological function. This has been termed emergency preservation and resuscitation (EPR). A systematic review of the literature was used to examine the evidence base behind the use of deep and profound hypothermia in haemorrhagic shock (HS). It included original research articles (human or animal) with cooling to ≤20°C after HS or an experimental model replicating it. Normovolaemic cardiac arrest, central nervous system injury and non-HS models were excluded. Twenty articles using 456 animal subjects were included, in which 327 were cooled to ≤20°C. All studies describing good survival rates were possible using EPR and 19/20 demonstrated that EPR can preserve neurological function after prolonged periods of circulatory arrest or minimal circulatory flow. This additional period...Continue Reading

References

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Oct 27, 2015·International Journal of Surgery·Matthew E KutcherSamuel A Tisherman

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Citations

Jul 6, 2018·Journal of the Royal Army Medical Corps·Johno Breeze
Aug 31, 2017·Journal of the Royal Army Medical Corps·Samuel Tisherman, J O'Connor
Feb 12, 2019·Intensive Care Medicine·Karim BrohiJohn B Holcomb
Feb 15, 2018·Journal of the Royal Army Medical Corps·Olivier JavaudinA Sailliol

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