Essay on "Therapeutic Hypothermia (Th): Literature Review"

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Therapeutic hypothermia (TH): Literature review

Therapeutic hypothermia (TH) is a form of medical treatment designed for severe and traumatic medical situations, such as resuscitating patients with cardiac conditions as well as treating traumatic brain injuries resulting from impact and/or stroke. This paper will provide a literary review of various types of recent studies on the efficacy of the TH technique.

Therapeutic hypothermia: Literature review of evidence, tools, and results

The need for improved, immediate treatment of cardiac patients has long been manifest to the medical community. According to Eisenburger et al. (2001) in the study "Therapeutic hypothermia after cardiac arrest: Current opinion in critical care" resuscitation of cardiac patients is required in more than "190 people per day in the United States and 50 to 66 per 100,000 per year in Europe" (Eisenburger 2001: 184). TH is often cited as a potentially useful technique to improve survival rates of cardiac patients. However, most studies of therapeutic hypothermia have been relatively small. A study by Tran et al. (2010) entitled "Use of mild therapeutic hypothermia to treat cardiac arrest" involved only a comparison of 77 patients from four different Australian hospitals.

Tran (2010) concluded that the use of TH on cardiac patients could improve both short-term neurologic recovery and long-term survival. Tran justified the limited size of the research population because of the study's diversity of cardiac patients, although he did note that further study was required. The fact that the procedure "decreases energy use and oxygen consumption in the brain and heart and glucose consumption during the early stages of cardiac arrest" and showed improved outcomes suggests that the technique could be valuable (Tran et al. 2010).

Hovdenes, J. et al. (2007)'s study, "Therapeutic hypothermia after out-of-hospital cardiac arrest: experiences with patients treated with percutaneous coronary intervention and cardiogenic shock" also supported the use of therapeutic hypothermia. This study involved 50 patients at a Norwegian hospital and, regardless of whether the therapy was administered at a local or referring hospital, neurological and survival outcomes were improved in patients that received TH. Another Scandinavian study, by Oksanen et al. (2007) in Finnish intensive care units was even more promising. Instead of comparing the improvement of a small population to the general population, Oksanen (2007) conducted a larger, cross-sectional study, comparing the improvement rates at 20 hospitals that used TH, a total of 407 affected cardiac patients that received the treatment. "The proportion of cardiac arrest patients treated with TH had increased from 4% in 2002 to 28% in 2005. The incidence of cardiac arrest patients admitted to ICUs was 15/100,000 inhabitants/year. The use of TH varied in different areas of the country from 3.4 to 5.0/100,000 inhabitants/year. in-hospital mortality of TH patients was 32.7% and increased from 13.2% in age group" (Oksanen 2007: 866). In the Oksanen study, younger patients treated with TH had a significantly better survival rate: the larger numbers in this study and the meticulous demographic data allowed for a more refined conclusion than some other TH studies. However, this study merely demonstrated a correlation between the increased use of TH and improved outcome rates of cardiac patients at the hospitals in question, rather than demonstrated a clear cause-and-effect relationship.

Literature reviews of TH studies on wider populations of patients have been less promising. Sayre et al. (2010) in the Ohio Department of Public Safety study "Effect of pre-hospital therapeutic hypothermia on neurologic outcome following sudden cardiac arrest" conducted a review of 450 resuscitations in medical literature. Sayre et al. (2010) found that TH caused neither a negative -- nor a positive -- improvement in patient survival or neurological improvement. The one positive finding for advocates of the technique is that the Sayre study does validate TH safety, a finding also confirmed by an… READ MORE

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