Israel: United States: United Kingdom:

Mennen Medical Ltd. Mennen Medical Mennen Medical UK

4 Ha-Yarden Street, Yavne, Corp. Unit 18 Avant Business Center
P.O. Box 102, 950 Industrial Blvd. 21 Denbigh Road
Rehovot 76100, Israel Southampton, Milton Keynes MK1 1DT, UK
Phone: +972-8-9323333 PA 18966-4070, USA Phone: +44 1908 646070
Fax: +972-8-9328510 Phone: +215 259-1020 Fax: +44 1908 646030
Fax: +215 675-6212
 Abstracts from Scientific Articles
1. Therapeutic Hypothermia for Comatose Survivors after Cardiac Arrest
Avishag Laish-Farkash MD PhD, Shlomi Matetzky MD, Samer Kassem MD, Hanny Haj-Iahia BA RCCN and Hanoch Hod MD
IMAJ 2007;9:252–256

Abstract
Background: Unconscious adults with spontaneous circulation after out-of-hospital cardiac arrest should be
cooled to 32–34ºC (ILCOR recommendations, 2003) when the initial rhythm is ventricular fibrillation.
Objectives: To assess the technique, safety and efficacy of mild induced hypothermia in patients after OHCA due
to VF.
Methods: Patients were cooled using the MTRE CritiCool™ external cooling system. Cold intravenous fluids were
added to achieve faster cooling in 17 patients. Data were collected prospectively and patients were analyzed
according to their neurological outcome on discharge, defined by their cerebral performance category.
Results: From February 2002 to September 2006, 51 comatose VF patients with OHCA underwent MIH.
Treatment was discontinued early in five because of hemodynamic instability; goal temperature was reached in
98% and maintained for an average of 19.5 hours; 61% had a favorable outcome (CPC 1–2) and 37% died.
Improved outcome was observed with longer hypothermia time and possibly when time from collapse to return
of spontaneous circulation was < 25 minutes.
Conclusions: MIH, using an external cooling system, is simple and feasible, reduces mortality and protects
neurological function. Four major factors seem to influence outcome: age, co-morbidities, duration of
hypothermia, and possibly the length of time from collapse to return of spontaneous circulation.

2. Mild Therapeutic Hypothermia Shortens Intensive Care Unit Stay of Survivors after Out-Of-Hospital
Cardiac Arrest Compared to Historical Controls

Storm C, Steffen I, Schefold JC, Krueger A, Oppert M, Jörres A, Hasper D.

Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Nephrology and Medical Intensive Care Medicine,
Augustenburger Platz 1, 13353 Berlin, Germany
Crit Care. 2008;12(3):R78.

Abstract
Introduction: Persistent coma is a common finding after cardiac arrest and has profound ethical and economic
implications. Evidence suggests that therapeutic hypothermia improves neurological outcome in these patients.
In this analysis, we investigate whether therapeutic hypothermia influences the length of intensive care unit
(ICU) stay and ventilator time in patients surviving out-of-hospital cardiac arrest.
Methods: A prospective observational study with historical controls was conducted at our medical ICU.
Fifty-two consecutive patients (median age 62.6 years, 43 males, 34 ventricular fibrillation) submitted to
therapeutic hypothermia * after out-of-hospital cardiac arrest were included. They were compared with a
historical cohort (n = 74, median age 63.8 years, 53 males, 43 ventricular fibrillation) treated in the era prior
to hypothermia treatment. All patients received the same standard of care. Neurological outcome was
assessed using the Pittsburgh cerebral performance category (CPC) score. Univariate analyses and multiple
regression models were used.
Results: In survivors, therapeutic hypothermia and baseline disease severity (Acute Physiology and
Chronic Health Evaluation II [APACHE II] score) were both found to significantly influence ICU stay and ventilator
time (all P < 0.01). ICU stay was shorter in survivors receiving therapeutic hypothermia (median 14 days
[interquartile range (IQR) 8 to 26] versus 21 days [IQR 15 to 30] in the control group; P = 0.017). ICU length of
stay and time on ventilator were prolonged in patients with CPC 3 or 4 compared with patients with CPC 1 or 2 (P
= 0.003 and P = 0.034, respectively). Kaplan-Meier analysis showed improved probability for 1-year survival in
the hypothermia group compared with the controls (log-rank test P = 0.013).
Conclusion: Therapeutic hypothermia was found to significantly shorten ICU stay and time of mechanical
ventilation in survivors after out-of-hospital cardiac arrest. Moreover, profound improvements in both
neurological outcome and 1-year survival were observed.

* The CritiCool®; MTRE, Yavne, Rehovot, Israel was one of the systems used to Induce Therapeutic hypothermia
in the patients, as written in the Full text article. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2481476/

3. Hypothermia: A Neuroprotective Therapy for Neonatal Hypoxic Ischemic Encephalopathy

Kyla Marks MBBS MPhD 1 , Eilon Shany MD 1 , Ilan Shelef MD 2 , Agneta Golan MD 1 and Ehud Zmora MD 1
IMAJ 2010; 12: 494–500

Abstract
The incidence of hypoxic ischemic encephalopathy in the United States is 2.8/1000 live births of which 10–15% of
the infants succumb and 25–30% suffer permanent neurologic damage: mental retardation, cerebral palsy and
epilepsy.
The incidence is tenfold higher in the developing world. Experimental evidence has confirmed that HIE is an
evolving process lasting hours to weeks. Understanding the mechanisms that culminate in neuronal death has
enabled the development of therapeutic strategies that limit the extent of the injury. Mild hypothermia is the
most rigorously tested of these strategies and has been the subject of several recently published international
multicenter randomized controlled trials. The results provide extensive information regarding the effectiveness
and safety of this treatment in the management of the infants most at risk of significant brain injury. In this
review, we present mechanisms of neuronal injury, the effect of hypothermia on these processes, and the results
of the clinical trials. In addition, we present our experience with mild hypothermia in the treatment of moderate-
severe HIE at Soroka Medical Center **.

** The CritiCool®; MTRE, Yavne, Rehovot, Israel is the system used in this center to Induce Therapeutic
hypothermia, as written in the Full text article. http://www.ima.org.il/imaj/ar10aug-09.pdf

4. Introduction of an External Noninvasive Cooling Device for Effective Implementation of Intensive

Care Society Standards Post Cardiac Arrest
J McGrath, K Williams, D Howell and J Down
University College Hospital London, UK

Introduction
Despite cardiac arrests accounting for 5.8% of admissions to intensive care, there is significant variation in the
management and outcome of these patients in different units. Randomized controlled trials have demonstrated
that active cooling to 32 to 34°C for 12 to 24 hours after return of spontaneous circulation (ROSC) significantly
improves the outcome of patients who have an out-of-hospital ventricular fibrillation arrest. However there are a
range of cooling techniques employed, and no trials have demonstrated that any particular system is superior.
Methods
All adult patients admitted to critical care following out-of-hospital cardiac arrest with Glasgow coma scale <9
after ROSC were included. The initial audit included nine patients admitted between August 2006 and March
2007 who were cooled primarily with standard methods such as ice packs/cooling pads. Performance was re-
audited between August 2007 and December 2007 following the introduction of CritiCool, and included nine
patients. Data were collected using an audit form, a computerized ICU patient database (CIMS) and clinical notes.
We assessed neurological outcome at ICU discharge by calculating the cerebral performance category (CPC). The
CPC is scored on a scale (0 to 5) where higher scores indicate worse functional impairment.
Results
Following introduction of the CritiCool there was improvement in the speed of cooling to the target temperature
range (patients effectively cooled within 4 hours: 33% vs. 57%). There was also improved ability to maintain
patients within the target temperature range over the 24-hour period (57% vs. 70%). There was also a trend
towards improvement in the mean CPC score at ICU discharge from 3.4 to 2.3.
Conclusion
We have shown an improvement in the speed of cooling and target temperature maintenance. Our study also
shows that the introduction of CritiCool correlated with an improvement in CPC. We suggest that more
widespread use of noninvasive cooling devices may improve implementation of standards, avoid risks associated
with invasive cooling devices and potentially improve neurological outcome.