The present work describes the design of a device/system intended to induce local mild hypothermia by simultaneously cooling a patient's head and neck. The therapeutic goal is to lower the head and neck temperatures to 33–35 °C, while leaving the core body temperature unchanged. The device works by circulating a cold fluid around the exterior of the head and neck. The head surface area is separated into five different cooling zones. Each zone has a cooling coil and can be independently controlled. The cooling coils are tightly wrapped concentric circles of tubing. This design allows for a dense packing of tubes in a limited space, while preventing crimping of the tubing and minimizing the fluid pressure head loss. The design in the neck region also has multiple tubes wrapping around the circumference of the patient's neck in a helix. Preliminary testing indicates that this approach is capable of achieving the design goal of cooling the brain tissue (at a depth of 2.5 cm from the scalp) to 35 °C within 30– 40 min, without any pharmacologic or circulatory manipulation. In a comparison with examples of current technology, the device has shown the potential for improved cooling capability.
Issue Section:
Research Papers
References
1.
Krieger
, D. W.
, De Georgia
, M. A.
, Abou-Chebl
, A.
, Andrefsky, J. C., Sila, C. A., Katzan, I. L., Mayberg, M. R., and Furlan, A. J., 2001
, “Cooling for Acute Ischemic Brain Damage (Cool Aid): An Open Pilot Study of Induced Hypothermia in Acute Ischemic Stroke
,” Stroke
, 32
(8
), pp. 1847
–1854
.10.1161/01.STR.32.8.18472.
Faridar
, A.
, Bershad
, E. M.
, Emiru
, T.
, Iaizzo
, P. A.
, Suarez
, J. I.
, Divani
, A. A.
, 2012
, “Therapeutic Hypothermia in Stroke and Traumatic Brain Injury
,” Front. Neurol.
, 2
(80), pp. 1–11.10.3389/fneur.2011.000803.
Adelson
, P. D.
, Ragherb
, J.
, Muizelaar
, J. P.
, Kanev, P., Brockmeyer, D., Beers, S. R., Brown, S. D., Cassidy, L. D., Chang, Y., and Levin, H., 2005
, “Phase II Clinical Trial of Moderate Hypothermia After Severe Traumatic Brain Injury in Children
,” Neurosurgery
, 56
(4
), pp. 740–754.10.1227/01.NEU.0000156471.50726.264.
Arcure
, J.
, and Harrison
, E.
, 2009
, “A Review of the Use of Early Hypothermia in the Treatment of Traumatic Brain Injuries
,” J. Spec. Oper. Med.
, 9
(3
), p. 22
.5.
Bernard
, S. A.
, and Buist
, M.
, 2003
, “Induced Hypothermia in Critical Care Medicine: A Review
,” Crit. Care Medi.
, 31
(7
), pp. 2041–2051.10.1097/01.CCM.0000069731.18472.616.
Den Hertog
, H. M.
, Van Der Worp
, H. B.
, Tseng
, M. C.
, and Dippel
, D. W.
, 2009
, “Cooling Therapy for Acute Stroke
,” Cochrane Database Syst Rev.
, 21
(1
), p. CD001247
.10.1002/14651858.CD001247.pub27.
Duz
, B.
, Oztas
, E.
, Erginay
, T.
, Erdogan
, E.
, and Gonul
, E.
, 2007
, “The Effect of Moderate Hypothermia in Acute Ischemic Stroke on Pericyte Migration: An Ultrastructural Study
,” Cryobiology
55
(3
), pp. 279
–284
.10.1016/j.cryobiol.2007.08.0098.
Lyden
, P. D.
, Krieger
, D.
, Yenari
, M.
, and Dietrich
, W. D.
, 2006
, “Therapeutic Hypothermia for Acute Stroke
,” Int. J. Stroke
, 1
(1
), pp. 9
–19
.10.1111/j.1747-4949.2005.00011.x9.
McIntyre
, L. A.
, Fergusson
, D. A.
, Hébert
, P. C.
, Moher
, D.
, and Hutchison
, J. S.
, 2003
, “Prolonged Therapeutic Hypothermia After Traumatic Brain Injury in Adults
,” JAMA
, 289
(22
), p. 2992
.10.1001/jama.289.22.299210.
Polderman
, K. H.
, van Zanten
, A. R.
, Nipshagen
, M. D.
, and Girbes
, A. R.
, 2004
, “Induced Hypothermia in Traumatic Brain Injury: Effective if Properly Employed
,” Crit. Care Med.
, 32
(1
), pp. 313
–314
.10.1097/01.CCM.0000104936.28288.7A11.
Puccio
, A. M.
, Fischer
, M. R.
, Jankowitz
, B. T.
, Yonas
, H.
, Darby
, J. M.
, and Okonkwo
, D. O.
, 2009
, “Induced Normothermia Attenuates Intracranial Hypertension and Reduces Fever Burden After Severe Traumatic Brain Injury
,” Neurocrit. Care
, 11
(1
), pp. 82
–87
.10.1007/s12028-009-9213-012.
van der Worp
, H. B.
, Macleod
, M. R.
, and Kollmar
, R.
, 2010
, “Therapeutic Hypothermia for Acute Ischemic Stroke: Ready to Start Large Randomized Trials?
,” J. Cereb. Blood Flow Metab.
, 30
(6
), pp. 1079
–1093
.10.1038/jcbfm.2010.4413.
Hemmen
, T. M.
, and Lyden
, P. D.
, 2009
, “Hypothermia After Acute Ischemic Stroke
,” J. Neurotrauma
, 26
(3
), pp. 387
–391
.10.1089/neu.2008.057414.
Kollmar
, R.
, Henninger
, N.
, Bardutzky
, J.
, Schellinger
, P. D.
, Schabitz
, W. R.
, and Schwab
, S.
, 2004
, “Combination Therapy of Moderate Hypothermia and Thrombolysis in Experimental Thromboembolic Stroke—An MRI Study
,” Exper. Neurol.
, 190
(1
), pp. 204
–212
.10.1016/j.expneurol.2004.07.00615.
Gunn
, A.
, and Thoresen
, M.
, 2006
, “Hypothermic Neuroprotection
,” NeuroRx
, 3
(2
), pp. 154
–169
.10.1016/j.nurx.2006.01.00716.
Hu
, W.-W.
, Du, Y., Li, C., Song, Y.-J., and Zhang, G.-Y., 2008
, “Neuroprotection of Hypothermia Against Neuronal Death in Rat Hippocampus Through Inhibiting the Increased Assembly of GluR6-PSD95-MLK3 Signaling Module Induced by Cerebral Ischemia/Reperfusion
,” Hippocampus
, 18
(4
), pp. 386
–397
.10.1002/hipo.2040217.
Yenari
, M.
, Kitagawa
, K.
, Lyden
, P.
, and Perez-Pinzon
, M.
, 2008
, “Metabolic Downregulation: A Key to Successful Neuroprotection?
,” Stroke
, 39
(10
), pp. 2910
–2917
.10.1161/STROKEAHA.108.51447118.
Yenari
, M. A.
, Wijman
, C.
, and Steinberg
, G.
, 2008
, “Effects of Hypothermia on Cerebral Metabolism, Blood Flow, and Autoregulation
,” Therapeutic Hypothermia
, S. A.
Mayer
, and D. I.
Sessler
, eds., Marcel Dekker
, New York
, pp. 141
–178
.19.
Karibe
, H.
, Chen
, J.
, Zarow
, G. J.
, Graham
, S. H.
, and Weinstein
, P. R.
, 1994
, “Delayed Induction of Mild Hypothermia to Reduce Infarct Volume After Temporary Middle Cerebral Artery Occlusion in Rats
,” J. Neurosurg.
, 80
(1
), pp. 112
–119
.10.3171/jns.1994.80.1.011220.
Xue
, D.
, and Huang
, Z.
, 1992
, “Immediate or Delayed Mild Hypothermia Prevents Focal Cerebral Infarction
,” Brain Res.
, 587
(1
), pp. 66
–72
.10.1016/0006-8993(92)91428-H21.
Parent
, A.
, and Carpenter
, M. B.
, 1996
, Carpenter's Human Neuroanatomy
, Williams and Wilkins
, Baltimore
.22.
Xu
, X.
, Tikuisis
, P.
, and Giesbrecht
, G.
, 1999
, “A Mathematical Model for Human Brain Cooling During Cold-Water Near-Drowning
,” J. Appl. Physiol.
, 86
(1
), pp. 265
–272
.23.
Shitzer
, A.
, and Eberhart
, R. C.
, 1985
, Heat Transfer in Medicine and Biology
, Springer
, New York
, pp. 312
–320
.24.
Konstas
, A. A.
, Neimark
, M. A.
, Laine
, A. F.
, and Pile-Spellman
, J.
, 2007
, “A Theoretical Model of Selective Cooling Using Intracarotid Cold Saline Infusion in the Human Brain
,” J. Appl. Physiol.
, 102
(4
), pp. 1329–1340.10.1152/japplphysiol.00805.200625.
Wang
, Y.
, and Zhu
, L.
, 2007
, “Targeted Brain Hypothermia Induced by an Interstitial Cooling Device in Human Neck: Theoretical Analyses
,” Eur. J. Appl. Physiol.
, 101
(1
), pp. 31
–40
.10.1007/s00421-007-0451-626.
Dae
, M. W.
, Gao
, D. W.
, Ursell
, P. C.
, Stillson
, C. A.
, and Sessler
, D. I.
, 2003
, “Safety and Efficacy of Endovascular Cooling and Rewarming for Induction and Reversal of Hypothermia in Human-Sized Pigs
,” Stroke
, 34
(3
), pp. 734
–738
.10.1161/01.STR.0000057461.56040.FE27.
Luan
, X.
, Li
, J.
, McAllister, J. P. II, Diaz, F. G., Clark, J. C., Fessler, R. D., and Ding, Y., 2004
, “Regional Brain Cooling Induced by Vascular Saline Infusion Into Ischemic Territory Reduces Brain Inflammation in Stroke
,” Acta Neuropathol. (Berl)
, 107
(3
), pp. 227
–234
.10.1007/s00401-003-0802-228.
Holzer
, M.
, Behringer
, W.
, Janata
, A.
, Bayegan, K., Schima, H., Deckert, Z., Losert, U., Laggner, A. N., and Sterz, F., 2005
, “Extracorporeal Venovenous Cooling for Induction of Mild Hypothermia in Human-Sized Swine
,” Crit. Care Med.
, 33
(6
), pp. 1346
–1350
.10.1097/01.CCM.0000166356.45902.A229.
Georgiadis
, D.
, Schwarz
, S.
, Kollmar
, R.
, and Schwab
, S.
, 2001
, “Endovascular Cooling for Moderate Hypothermia in Patients With Acute Stroke: First Results of a Novel Approach
,” Stroke
, 32
(11
), pp. 2550–2553.10.1161/hs1101.09738230.
Pichon
, N.
, Amiel
, J. B.
, Francois
, B.
, Dugard
, A.
, Etchecopar
, C.
, and Vignon
, P.
, 2007
, “Efficacy of and Tolerance to Mild Induced Hypothermia After Out-of-Hospital Cardiac Arrest Using an Endovascular Cooling System
,” Crit. Care
, 11
(3
), p. R71
.10.1186/cc595631.
Diller
, K. R.
, and Zhu
, L.
, 2009
, “Hypothermia Therapy for Brain Injury
,” Annu. Rev. Biomed. Eng.
, 11
, pp. 135
–162
.10.1146/annurev-bioeng-061008-12490832.
Lampe
, J. W.
, and Becker
, L. B.
2007
, “Rapid Cooling for Saving Lives: A Bioengineering Opportunity
,” Exp. Rev. Med. Devices
, 4
(4
), pp. 441
–446
.10.1586/17434440.4.4.44133.
Wang
, H.
, Olivero
, W.
, Lanzino
, G.
, Elkins, W., Rose, J., Honings, D., Rodde, M., Burnham, J., and Wang, D., 2004
, “Rapid and Selective Cerebral Hypothermia Achieved Using a Cooling Helmet
,” J. Neurosurg.
, 100
(2
), pp. 272
–277
.10.3171/jns.2004.100.2.027234.
Qiu
, W.
, Shen
, H.
, Zhang
, Y.
, Wang, W., Liu, W., Jiang, Q., Luo, M., and Manou, M., 2006
, “Noninvasive Selective Brain Cooling by Head and Neck Cooling is Protective in Severe Traumatic Brain Injury
,” J. Clin. Neurosci.: Neurosurg. Soc. Australas.
, 13
(10
), pp. 995
–1000
.10.1016/j.jocn.2006.02.02735.
Liu
, W. G.
, Qiu
, W. S.
, Zhang
, Y.
, Wang
, W. M.
, Lu
, F.
, and Yang
, X. F.
, 2006
, “Effects of Selective Brain Cooling in Patients With Severe Traumatic Brain Injury: A Preliminary Study
,” J. Int. Med. Res.
, 34
(1
), pp. 58
–64
.10.1177/14732300060340010736.
Hachimi-Idrissi
, S.
, Corne
, L.
, Ebinger
, G.
, Michotte
, Y.
, and Huyghens
, L.
, 2001
, “Mild Hypothermia Induced by a Helmet Device: A Clinical Feasibility Study
,” Resuscitation
, 51
(3
), pp. 275
–281
.10.1016/S0300-9572(01)00412-937.
Polderman
, K. H.
, and Herold
, I.
, 2009
, “Therapeutic Hypothermia and Controlled Normothermia in the Intensive Care Unit: Practical Considerations, Side Effects, and Cooling Methods
,” Crit. Care Med.
, 37
(3
), pp. 1101–1120.10.1097/CCM.0b013e3181962ad538.
Holzer
, M.
, 2008
, “Devices for Rapid Induction of Hypothermia
,” Eur. J. Anaesthesiol. Suppl.
, 42
, pp. 31
–38
.10.1017/S026502150700327439.
McKean
, S.
, 2009
, “Induced Moderate Hypothermia After Cardiac Arrest
,” AACN Adv. Crit. Care
, 20
(4
), pp. 342
–353
.10.1097/NCI.0b013e3181bcea4e40.
Ku
, Y. T.
, Montgomery
, L. D.
, Webbon
, B. W.
, 1996
, “Hemodynamic And Thermal Responses to Head and Neck Cooling in Men and Women
,” Am. J. Phys. Med. Rehabil.
, 75
(6
), pp. 443
–450
.10.1097/00002060-199611000-0000841.
Janssen
, F. P.
, Rajan
, V.
, Steenbergen
, W.
, van Leeuwen
, G. M.
, and van Steenhoven
, A. A.
, 2007
, “The Relationship Between Local Scalp Skin Temperature and Cutaneous Perfusion During Scalp Cooling
,” Physiol. Meas.
, 28
(8
), pp. 829
–839
.10.1088/0967-3334/28/8/00642.
Laptook
, A. R.
, Shalak
, L.
, and Corbett
, R. J.
, 2001
, “Differences in Brain Temperature and Cerebral Blood Flow During Selective Head Versus Whole-Body Cooling
,” Pediatrics
, 108
(5
), pp. 1103
–1110
.10.1542/peds.108.5.110343.
Dennis
, B. H.
, Eberhart
, R. C.
, Dulikravich
, G. S.
, and Radons
, S. W.
, 2003
, “Finite-Element Simulation of Cooling of Realistic 3-D Human Head and Neck
,” ASME J. Biomech. Eng.
, 125
(6
), pp. 832
–840
.10.1115/1.163499144.
Diao
, C.
, Zhu
, L.
, and Wang
, H.
, 2003
, “Cooling and Rewarming for Brain Ischemia or Injury: Theoretical Analysis
,” Ann. Biomed. Eng.
, 31
(3
), pp. 346
–353
.10.1114/1.155492445.
Janssen
, F. E.
, van Leeuwen
, G. M.
, and van Steenhoven
, A. A.
, 2005
, “Modelling of Temperature and Perfusion During Scalp Cooling
,” Phys. Med. Biol.
50
(17
), pp. 4065
–4073
.10.1088/0031-9155/50/17/01046.
Nelson
, D. A.
, and Nunneley
, S. A.
, 1998
, “Brain Temperature and Limits on Transcranial Cooling in Humans: Quantitative Modeling Results
,” Eur. J. Appl. Physiol.
, 78
(4
), pp. 353
–359
.10.1007/s00421005043147.
Zhu
, L.
, and Rosengart
, A. J.
, 2008
, “Cooling Penetration Into Normal and Injured Brain Via Intraparenchymal Brain Cooling Probe: Theoretical Analyses
,” Heat Transfer Eng.
, 29
(3
), pp. 284
–294
.10.1080/0145763070175806248.
Neimark
, M. A.
, Konstas
, A. A.
, Choi
, J. H.
, Laine
, A. F.
, and Pile-Spellman
, J.
, 2008
, “Brain Cooling Maintenance With Cooling Cap Following Induction With Intracarotid Cold Saline Infusion: A Quantitative Model
,” J. Theor. Biol.
, 253
(2
), pp. 333
–344
.10.1016/j.jtbi.2008.03.02549.
Holman
, J. P.
, 2001
, Heat Transfer
, McGraw-Hill
, New York
.50.
Bergman
, T. L.
, Lavine
, A. S.
, Dewitt
, D. P.
, and Incropera
, F. P.
, 2011
, Introduction to Heat Transfer
, John Wiley and Sons
, Hoboken, NJ
, pp. 298
–310
.51.
Schneider
, P. J.
, 1957
, Conduction of Heat Transfer
, Addison-Wesley
, Cambridge, MA
, pp. 250
–265
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