Lowering body temp shows promise for trauma treatment

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Lowering body temp shows promise for trauma treatment

By JACOB GOLDSTEIN
jgoldstein@MiamiHerald.com
Twenty years ago, W. Dalton Dietrich and his colleagues had a problem: the rats in their laboratory experienced the same kind of stroke but had dramatically different outcomes.
''We were perplexed,'' Dietrich says.
To try to figure out what was going on, they started measuring the temperature of the rats' brains. The results were shocking.
Rats whose brains were just a few degrees cooler than normal fared far better than others. Outcomes for those whose brains were a few degrees warmer than normal were, in Dietrich's words, ``really, really, really bad.''
That discovery inspired new interest in an old idea that had lost favor: using hypothermia to help patients who have suffered grave harm to the heart, brain or spinal cord. Now research is moving out of the laboratory and into the clinic. Some studies have shown no benefit from inducing hypothermia, but others have shown great promise.
Doctors are using a wide range of techniques for cooling -- from simple ice packs to high-tech machines that run cold fluid through the veins. Specific treatments vary, but patients are typically cooled until their body temperature is in the low 90s (98.6 is normal), and kept that way for 12 to 48 hours. Treatment must be started early -- usually within hours of the injury or cardiovascular event.
Last year, following the publication of two major studies, the American Heart Association recommended inducing hypothermia in some patients after cardiac arrest. Doctors at Jackson Memorial Hospital plan to adopt the recommendations in the coming months, said Dr. Kathy Schrank, who runs the hospital's emergency department.
In other studies, doctors are cooling oxygen-deprived newborns as well as adults who have suffered strokes, heart attacks and traumatic brain injuries.
At the Miami Project to Cure Paralysis, where Dietrich is now scientific director, researchers are trying to understand exactly how temperature variations affect cell behavior. And Dr. Barth Green, the Miami Project's co-founder, is inducing hypothermia in some of the most gravely injured spinal cord patients in the minutes or hours after they arrive at the trauma center.

http://www.miami.com/mld/miamiherald...g/14470751.htm