Abstract
Dear Colleagues:
The current issue, our first in 2013, highlights two expert panel discussions/roundtables, which were held at a March 2012 scientific symposium in Miami, Florida, targeting therapeutic hypothermia and temperature management. One discussion focuses on recent work in preclinical and clinical studies of therapeutic hypothermia and cerebral ischemia and stroke. Questions regarding the continued development of clinical protocols for targeting the devastating consequences of cardiac arrest and focal ischemia are examined. Most interesting is the current use of combination approaches that include thrombolytic agents plus mild cooling to extend the window of therapeutic interventions for acute stroke patients.
The second roundtable discussion looks at managing hypothermia during organ transplantation and cardiac arrest. Clinical data emphasize the benefits of early cooling after cardiac arrest, and the clinical field continues to develop new treatment strategies to target larger numbers of subjects that can benefit from this therapy. Other discourse focuses on the use of hypothermia during organ transplantation, which plays a critical role in maximizing the benefits of organ transplantation to donors.
An informative review article covers the use of cooling for brain injuries of near-hanging victims. Hanging, strangulation, and suffocation constitute the second most common cause of death by suicide in the United States after firearms. Recent data indicate hypothermia treatment is effective in neurologic outcome and survival.
An original article by Dr. Youn and colleagues provides an extensive discussion of a single institution experience in South Korea using post–cardiac arrest hypothermia after out-of-hospital cardiac arrest. This retrospective study provides important information regarding how successful implementation of a comprehensive package for this therapy can be introduced.
In another original article, Dr. Lyden and colleagues discuss determinants of pneumonia risk during endovascular hypothermia. Long-term cooling protocols can be associated with a number of risk factors, including increased pneumonia, that can severely affect the patient recovery. Thus, determining what procedural factors can minimize the detrimental effects of pneumonia is critically important to the field.
Also included in this issue is an editorial commentary regarding a previously published study in our journal. Hiploylee and Colbourne provide their thoughts on the article by Katz et al. (2012). This original study discussed the feasibility of inducing hypothermia in a swine model of asphyxial cardiac arrest. This highly translational model provides proof-of-concept and basis for future studies. Finally, the special section Arctic Challenge again addresses several important questions regarding strategies and risk factors associated with acute and long-term cooling. In the current installment, several strategies to produce hypothermia are discussed. The use of ice packs for therapeutic hypothermia management, for example, is examined in regards to the benefit of reducing the body temperature during the induction phase of hypothermia or augmenting efforts aimed at combating severe hyperthermia. A cooling helmet system is also being developed that, under some conditions, has been shown to reduce temperature several degrees below core body temperature. This approach, including preventing core body temperature to cool too rapidly, is emphasized.
Endovascular devices supplied by several companies are also explored as a way to induce, maintain, and control core temperature during extended periods of hypothermia. Upgrades and other improvements continue to be introduced into the field. Additionally, external cooling devices are being used in a variety of patient populations. Certainly, external cooling systems are useful for managing temperature and maintaining normothermia.
Relatively new approaches, including peritoneal lavage, that target both cardiac arrest patients as well as acute myocardial infarction patients have been described in the literature. Although more data are required, these approaches, where cooling can be obtained relatively quickly, appear promising. Finally, intranasal cooling systems, which allow coolants sprayed into the nasal cavity to cool the brain, are being introduced into the field. Recent experimental studies provide encouraging data on the use of intranasal cooling devices in specific patient populations.
Once again we'd like to thank our authors for their submissions of high-quality manuscripts and for considering this journal as a prime venue to present their work. Our internal editorial board and reviewers are most appreciated as they enhance the Journal by providing quality reviews. We continue to be committed to publishing timely manuscripts targeting a variety of basic and clinical questions being addressed in the field of medical treatments.
In my role as editor-in-chief, I hope you are enjoying the Journal. If you have any questions or would like to submit a Letter to the Editor, specifically addressing points made in our articles, please contact me at