Editor's Commentary

Dear Colleagues:

This issue of Therapeutic Hypothermia and Temperature Management again contains a series of original articles concerning the use of therapeutic hypothermia and temperature management strategies in both experimental and clinical conditions. The issue opens with two key Editorial Commentaries. In the first piece, the induction of mild hypothermia by non-invasive body cooling in healthy unanesthetized subjects, Hans Friberg comments on a recent paper by Bandschapp and Iaizzo regarding the clinical efficacy of several methods of reducing core temperature and subsequent physiological responses. The commentary emphasizes the need for more high-quality research in the hypothermia field to optimize temperature management for awake patients such as those with stroke or acute myocardial infarction. In a second Editorial Comment, Patrick Lyden discusses a paper published by Busch and Soreide that reports on a retrospective analysis of hypothermia in comatose survivors of out-of-hospital cardiac arrest. Interestingly, while good outcome was more likely to occur in young patients, hypothermic therapy also appeared to benefit older subjects. Further controlled trials are needed to determine and recommend therapeutic hypothermia for elderly victims of cardiac arrest. The Journal welcomes your commentaries on any articles or topics of interest to our readership.

In an original article, Heinius et al. addresses the concern of high-dose crystalloid use during traumatic hemorrhagic shock. These preclinical data using a moderate cooling strategy emphasize the importance of rate of fluid administration under hypothermic and rewarming conditions. In another study by Katz et al., a drug cocktail containing a mixture of ethanol, lydocane, and vasopressin is used to induce prolonged hypothermia in awake rats. Whether regulated hypothermia can be pharmacologically introduced in larger animals and ultimately man is an area of active research.

The effects of hypothermia on the degradation of endothelial IL-8 mRNA stimulated by inflammation are investigated by Sakurai et al. The importance of this study is the observation that while hypothermia suppressed inflammatory cytokine expression during the cooling phase, stabilized levels of mRNA during the cooling phase could lead to production of IL-8 after rewarming. Longer cooling strategies or the addition of pharmacological agents may be warranted to suppress long-term inflammatory events. Gonzalez et al. report on 106 cardiac arrest patients showing the presence of significant coronary lesions on subsequent angiography. The authors conclude that these patients, many of which received therapeutic hypothermia, demonstrate a high frequency of coronary lesions.

Finally, a study that sought the characterization, adoption, and implementation of hypothermia by acute care hospitals in the State of New Jersey is presented by DeLia et al. This paper emphasizes that while the majority of New Jersey hospitals are organized to implement therapeutic hypothermia in out-of-hospital cardiac arrest patients, limited volumes and lack of uniform procedures raise concern.

In addition to these original articles, a case report summarizing the use of endovascular catheters as a rewarming method for accidental hypothermia is presented. The study by Chua et al. provides an example of how cooling catheters can be used to rewarm a patient admitted to the emergency room with altered mental status and profound hypothermia.

An important function of the Journal is to provide up-to-date information regarding the latest topics discussed by the scientific community at national and international meetings. A series of 16 abstracts presented at this year's Therapeutic Hypothermia and Temperature Management International Symposium are provided in this issue. These abstracts provide the reader with a summary of timely points of discussion by authorities on hypothermia research.

Finally, the issue includes the next installment of “The Arctic Challenge,” a regular feature that discusses commonly asked clinical questions relevant to the everyday use of hypothermic therapy. Submitted questions are answered by a talented multidisciplinary team that provides a detailed summation with references of their experiences in terms of current practices in the field of temperature management and induced hypothermia. This current issue contains questions on designing metrics to review performance of a hypothermia protocol, getting hypothermia started following cardiac arrest, and how to increase temperature when it uncontrollably drops below the recommended level.

The Journal continues to provide a forum by which to circulate the most recent data and discussions regarding how to best use hypothermia and new clinical conditions that merit temperature monitoring. As Editor-in-Chief, I hope you are enjoying the contents of the Journal and continue to feel that it remains an important contribution to your field of research and clinical practice. I look forward to receiving your feedback, recognizing that this is critical as the Journal continues to progress. We are planning to submit our Journal for consideration for listing in Medline in the near future. This will be an important step in the evolution of our Journal.