Abstract
Dear Colleagues:
In an original article, Meunier et al. address the temperature effects on thrombolytic efficacy using recombinant tissue plasminigen activator (rt-PA) and GP IIb-IIIa inhibitors such as Eptifibatide. This study asks the critical question of how reactions triggered by these agents could be impacted by temperature fluctuations. Because therapeutic hypothermia is now being used to target stroke patients in combination with thrombolytic therapies, these data are timely and highly relevant to the field. In another original article, the role of therapeutic induced hypothermia on thoracoabdominal aneurysm surgery is discussed. Awad et al. provide a state-of-the-art review of the historical application of hypothermia in aortic surgery and how this intervention can reduce or eliminate the devastating consequences of ischemic spinal cord injury after aneurysm repair.
In a study by Joseph et al., a retrospective chart review of cardiac arrest patients at eight different institutions across the United States was conducted. This study was initiated to assess how therapeutic hypothermia is being implemented at different institutions and the feasibility of conducting research using multi-institutional prospective data. The authors provide information regarding the time of hypothermia initiation as well as length of cooling and long-term outcome.
Our journal also includes case reports that provide useful information regarding the use of hypothermia and temperature management strategies in specific patient populations. In a report by Shein et al., therapeutic hypothermia was used to target refractory status epilepticus in a child with malignant mitigating partial seizures. The authors report that no adverse effects of hypothermia treatment were noted in this four-month-old child, although seizures recurred 10 hours after rewarming. Interestingly, the authors propose that hypothermia in combination with the ketogenic diet may be effective in treating refractory status epilepticus in children, a very serious problem. Finally, the issue contains the next installment of “The Arctic Challenge,” a regular feature that discusses commonly asked clinical questions relevant to the everyday use of therapeutic hypothermia. Questions are answered by a talented multidisciplinary team that provides detailed summation of various experiences in terms of current practices in the field. In the current issue, how best to shorten the time it takes to reach target temperature in cardiac arrest patients where cooling blankets are being utilized is discussed. Another question relates to the use of hypothermia in pregnant patients and contrary indications for such a treatment strategy. The report indicates that more information regarding clinical experience could help guide decisions in this difficult patient population. Finally, the effects of hypothermia on the pharmacokinetics and pharmacodynamics of various drugs including anticoagulants and insulin are also introduced. Together, these and other questions provide valuable information to individuals interested in using this therapy for multiple patient populations.
The journal continues to provide a forum by which to circulate the most recent data and in depth discussions regarding how best to administer and utilize hypothermia. Basic science studies are providing critical information regarding mechanisms by which temperature may affect outcome, which help provide a rationale for future clinical investigations. 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. As always, I look forward to receiving your comments regarding our journal, recognizing that it is critical as we continue to improve the quality of the publications and message being presented to our readers.