In the PRINCE study, feasibility of preclinical transnasal cooling with evaporated perfluorcarbon that primarily leads to a prior selective cooling of the cerebrum was analyzed.
Retrograde cerebral perfusion (RCP) was initially considered to extend the safe operative time by both, backward perfusion of the brain via the superior cava vein at pressures of 20 to 30 mmHg, and selective cooling of the brain parenchyma.
Diverging wettable tracks on a superhydrophobic background provide the means to re-direct the impinging jet and enable spatially-selective cooling on the heated surface.
To sustain and regulate the brain temperature, many mechanisms of biological brain cooling have been evolved, including Selective Brain Cooling (SBC), cooling through surface water evaporation, respiration, behavior response and using special anatomical appendages.
38 Some studies suggest less severe brain MRI findings in babies who have had whole body cooling versus selective head cooling; other studies suggest equal benefit from both cooling methods.
If mild hypothermia is applied in TBI, cooling should take place within the first three hours following injury, preferably using selective brain cooling by cooling the head and neck, be maintained for at least 48 hours [ 218], rewarming should last 24 hours and the cerebral perfusion pressure should be maintained above 50 mmHg (systolic blood pressure ≥70 mmHg).
If mild hypothermia is applied in TBI, cooling should take place within the first 3 h following injury, preferably using selective brain cooling by cooling the head and neck, be maintained at least for >48 h, rewarming should last 24 h and the cerebral perfusion pressure should be maintained at >50 mmHg (systolic blood pressure ≥70 mmHg).
Review methods Reports that compared whole body cooling or selective head cooling with normal care in neonates with hypoxic-ischaemic encephalopathy and that included data on death or disability and on specific neurological outcomes of interest to patients and clinicians were selected.
Two RCTs involved selective head cooling by a cooling cap [ 10, 21], the other three involved whole body cooling [ 11, 12, 24].
The trials by Gunn et al 1998 and Gluckman et al 2005 (selective head cooling by a cooling cap) had primary composite outcome of death or s evere neurodevelopmental disability at 18 months defined as severe CP (equivalent to GMF level 3 to 5 in Gluckman et al 2005), Bayley mental developmental index (MDI) < 70, or bilateral cortical visual impairment.
