McGowan Institute for Regenerative Medicine faculty member Patrick Kochanek, MD, is presently a Professor at the University of Pittsburgh in the Department of Critical Care Medicine, Pediatrics and Anesthesiology. He is currently also an Associate Director in the Pediatric Intensive Care Unit, the Director in Pediatric Critical Care Research at Children’s Hospital of Pittsburgh, and Director at the Safar Center for Resuscitation Research in Pittsburgh. It is his role in the latter that was highlighted in the Fall 2007 issue of Pitt Med. In the article, “Inside the Blackout,” Dr. Kochanek highlighted the past efforts within the Safar Center and how they are supporting research today on the injured brain of a child.
The tools available to treat traumatic brain injury (TBI) are still limited. Doctors try to reduce intracranial pressure with medication and by draining cerebrospinal fluid. If this doesn’t work, neurosurgeons may remove a plate of bone from the skull to allow the brain room to swell. When the swelling decreases, the bone is replaced, perhaps several weeks later.
As part of a new clinical trial, children with TBIs who arrive at Children’s Hospital of Pittsburgh and 11 other hospitals in the country will now have access to an experimental therapy that induces hypothermia. This $14 million, multicenter trial funded by an NIH grant is the result of a former adult trial that followed the first experimental example of hypothermia’s benefit in head trauma that came from a Safar Center lab pediatric experiment more than 12 years ago. In that study, short bursts of hypothermia led to improved outcomes in young animals with head injury.
A child with TBI who is enrolled in the study is randomly assigned to receive either hypothermia or standard care. In those tagged for hypothermia, doctors push cold fluids through their veins. They wrap them in cooling blankets to further lower core temperature and keep it low for 2 or 3 days. From there, doctors will lower the body temperature down to 32 to 33 degrees centigrade, which is about 89 to 90 [degrees Fahrenheit]. That is a temperature that is cold enough that there is probably a good effect but it doesn’t have the complications. There is a long history of evidence leading to this promising trial, beginning with old news reports of children falling through winter ice into lakes and remaining under water for long periods of time—yet recovering completely.
Illustration: McGowan Institute for Regenerative Medicine.
Pitt Med (Fall 2007)
Safar Center for Resuscitation Research