Mild Hypothermia as Treatment in Cerebral Ischaemic Insult

The use of hypothermia in the clinical setting has it roots with the ancient Egyptians, Greeks and Romans. Hippocrates packed wounded soldiers in snow to reduce haemorrhage. In the early nineteenth century, Napoleon’s surgeon Baron Larrey noticed that wounded soldiers who were near a fire died quicker that those who remained hypothermic. Clinical interest in protective hypothermia began in the 1930s and 1940s, with observations and case reports describing successful resuscitation in patients after plunging in cold water. During this period, Fay first reported positive results from cooling severe brain-injured patients (Tempel Fay, 1943). Other small clinical trials were carried out in the 1960s. Despite occasionally encouraging results in patients, moderate hypothermia (28°–32°C) was abandoned because of uncertain benefits and management problems. Nevertheless, ‘hypothermia’ as ‘step H’ was inserted into cardiopulmonary resuscitation (CPR) sequences in 1961. It was then believed that hypothermia must be moderate (less than 32°C) in order to be beneficial.