Preface

Therapeutic hypothermia is becoming an important treatment for patients with acute brain injury, and is now under investigation for treatment of acute myocardial infarction. Although the cardiac and neuroprotective effects of hypothermia have been recognized in animals for decades, clinical interest was dormant until a resurgence of experimental studies in the early 1990's reawakened interest. These studies—many performed in the laboratory of one of our contributors, Dr. Myron Ginsberg—made it clear that even tiny variations in brain temperature powerfully modulate the extent of neuronal damage in various models of ischemic and traumatic brain injury.

Therapeutic hypothermia has attracted interest lately because pharmacologic interventions have consistently failed to improve outcome after stroke and trauma. Interest is largely predicated on evidence that hypothermia acts via a diverse array of molecular mechanisms and may thus prove to be the best method of inducing neuroprotection. This has led to an understanding that body temperature, like other physiologic parameters, should be deliberately optimized in individual patients. New technologies including circulating-water gar-ments and endovascular heat-exchange cathethers make it relatively easy to manipulate body temperature.

The apogee of clinical work in therapeutic hypothermia to date occurred in February of 2002 with the publication of two landmark clinical trials demonstrating dramatic improvement in outcome with mild-to-moderate hypothermia for survivors of out-of-hospital cardiac arrest. It is our expectation that these are just the first of many outcomes studies that will demonstrate the benefits of therapeutic hypothermia in various patient populations.

In short, therapeutic temperature modulation and hypothermia is not only a major new field of investigation, it is a new and important development in the clinical practice of emergency medicine, neurology, neurosurgery, critical care medicine, cardiology, and neurological and cardiac anesthesiology. Our purpose in creating this book was to provide health care providers and investigators with a comprehensive reference on this new and previously under-emphasized field of medicine. Our hope is that the information within will encourage clinicians to use therapeutic hypothermia when appropriate and investigators to develop new indications for therapeutic thermal management with the ultimate goal of saving lives and improving outcomes in patients with ischemic events.