Last week, we took you through all the ways that cold can harm us and the harrowing history of humans perishing at its icy hands. Ending the story there would be skipping over the parts where cold gets to play the hero, rather than the villain. In the second installment of this frosty miniseries, we explore the situations in which we might use cold to protect us and how it actually works. We also delve into the surprisingly long (and unsurprisingly grim) history of therapeutic hypothermia, a journey that wouldn’t be complete without a debate over sea cloaks, a reconsideration of the plot of Titanic, and a brief jaunt into cryonics.
| History | Biology |
| Jaekl, Phil. Out Cold: A Chilling Descent Into the Macabre, Controversial, Lifesaving History of Hypothermia. PublicAffairs, 2021. | Varon, J. and Acosta, P., 2008. Therapeutic hypothermia. Chest, 133(5), pp.1267-1274. |
| Alzaga, Ana G., Gloria A. Salazar, and Joseph Varon. “Breaking the thermal barrier: Dr. Temple Fay.” Resuscitation 69.3 (2006): 359-364. | Perman, S.M., Goyal, M., Neumar, R.W., Topjian, A.A. and Gaieski, D.F., 2014. Clinical applications of targeted temperature management. Chest, 145(2), pp.386-393. |
| Alzaga, Ana G., Mario Cerdan, and Joseph Varon. “Therapeutic hypothermia.” Resuscitation 70.3 (2006): 369-380. | Faix, R.G., Laptook, A.R., Shankaran, S., Eggleston, B., Chowdhury, D., Heyne, R.J., Das, A., Pedroza, C., Tyson, J.E., Wusthoff, C. and Bonifacio, S.L., 2025. Whole-body hypothermia for neonatal encephalopathy in preterm infants 33 to 35 weeks’ gestation: a randomized clinical trial. JAMA pediatrics, 179(4), pp.396-406. |
| Berger, Robert L. “Nazi science—the Dachau hypothermia experiments.” New England journal of medicine 322.20 (1990): 1435-1440. | Abate, B.B., Bimerew, M., Gebremichael, B., Mengesha Kassie, A., Kassaw, M., Gebremeskel, T. and Bayih, W.A., 2021. Effects of therapeutic hypothermia on death among asphyxiated neonates with hypoxic-ischemic encephalopathy: a systematic review and meta-analysis of randomized control trials. PloS one, 16(2), p.e0247229. |
| Carlson, Robert, et al. “Fifty-three years of follow-up of an infant with neonatal encephalopathy treated with therapeutic hypothermia.” Pediatric Research 89.5 (2021): 1117-1118. | Dankiewicz, J., Cronberg, T., Lilja, G., Jakobsen, J.C., Levin, H., Ullén, S., Rylander, C., Wise, M.P., Oddo, M., Cariou, A. and Bělohlávek, J., 2021. Hypothermia versus normothermia after out-of-hospital cardiac arrest. New England Journal of Medicine, 384(24), pp.2283-2294. |
| Chalak, Lina. “Historical perspectives for therapeutic hypothermia in the newborn: a life worth saving.” Pediatric Research 89.5 (2021): 1057-1058. | Bernard, S.A., Gray, T.W., Buist, M.D., Jones, B.M., Silvester, W., Gutteridge, G. and Smith, K., 2002. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. New England journal of medicine, 346(8), pp.557-563. |
| Currie, James. “X. An account of the remarkable effects of a shipwreck on the mariners; with experiments and observations on the influence of immersion in fresh and salt water, hot and cold, on the powers of the living body.” Philosophical Transactions of the Royal Society of London 82 (1792): 199-224. | Lascarrou, J.B., Merdji, H., Le Gouge, A., Colin, G., Grillet, G., Girardie, P., Coupez, E., Dequin, P.F., Cariou, A., Boulain, T. and Brule, N., 2019. Targeted temperature management for cardiac arrest with nonshockable rhythm. New England Journal of Medicine, 381(24), pp.2327-2337. |
| Gunn, Alistair J., et al. “Therapeutic hypothermia translates from ancient history in to practice.” Pediatric research 81.1 (2017): 202-209. | Nielsen, N., Wetterslev, J., Cronberg, T., Erlinge, D., Gasche, Y., Hassager, C., Horn, J., Hovdenes, J., Kjaergaard, J., Kuiper, M. and Pellis, T., 2013. Targeted temperature management at 33 C versus 36 C after cardiac arrest. New England journal of medicine, 369(23), pp.2197-2206. |
| Kochanek, Patrick M., Tomas Drabek, and Samuel A. Tisherman. “Therapeutic hypothermia: the Safar vision.” Journal of neurotrauma 26.3 (2009): 417-420. | Nielsen, N., Friberg, H., Gluud, C., Herlitz, J. and Wetterslev, J., 2011. Hypothermia after cardiac arrest should be further evaluated—a systematic review of randomised trials with meta-analysis and trial sequential analysis. International journal of cardiology, 151(3), pp.333-341. |
| Remba, Salomon Jasqui, et al. “Dominique-Jean Larrey: the effects of therapeutic hypothermia and the first ambulance.” Resuscitation 81.3 (2010): 268-271. | Perman, S.M., Elmer, J., Maciel, C.B., Uzendu, A., May, T., Mumma, B.E., Bartos, J.A., Rodriguez, A.J., Kurz, M.C., Panchal, A.R. and Rittenberger, J.C., 2024. 2023 American Heart Association focused update on adult advanced cardiovascular life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 149(5), pp.e254-e273. |
| Sessler, Daniel I. “Thermoregulatory defense mechanisms.” Critical care medicine 37.7 (2009): S203-S210. | Sessler, D.I., Pei, L., Li, K., Cui, S., Chan, M.T., Huang, Y., Wu, J., He, X., Bajracharya, G.R., Rivas, E. and Lam, C.K., 2022. Aggressive intraoperative warming versus routine thermal management during non-cardiac surgery (PROTECT): a multicentre, parallel group, superiority trial. The Lancet, 399(10337), pp.1799-1808. |
| Forrester, John M. “The origins and fate of James Currie’s cold water treatment for fever.” Medical history 44.1 (2000): 57-74. | Kwiecien, S.Y. and McHugh, M.P., 2021. The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise. European journal of applied physiology, 121(8), pp.2125-2142. |
| Clint, Edward, and Daniel MT Fessler. “Insurmountable heat: the evolution and persistence of defensive hyperthermia.” The Quarterly review of biology 91.1 (2016): 25-46. | Greenberg, S.M., Ziai, W.C., Cordonnier, C., Dowlatshahi, D., Francis, B., Goldstein, J.N., Hemphill III, J.C., Johnson, R., Keigher, K.M., Mack, W.J. and Mocco, J., 2022. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke, 53(7), pp.e282-e361. |
| Hoh, B.L., Ko, N.U., Amin-Hanjani, S., Chou, S.H.Y., Cruz-Flores, S., Dangayach, N.S., Derdeyn, C.P., Du, R., Hänggi, D., Hetts, S.W. and Ifejika, N.L., 2023. 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke, 54(7), pp.e314-e370. | |
| Powers, W.J., Rabinstein, A.A., Ackerson, T., Adeoye, O.M., Bambakidis, N.C., Becker, K., Biller, J., Brown, M., Demaerschalk, B.M., Hoh, B. and Jauch, E.C., 2019. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. | |
| Gocoł, R., Hudziak, D., Bis, J., Mendrala, K., Morkisz, Ł., Podsiadło, P., Kosiński, S., Piątek, J. and Darocha, T., 2021. The role of deep hypothermia in cardiac surgery. International journal of environmental research and public health, 18(13), p.7061. | |
| Abbasciano, R.G., Koulouroudias, M., Chad, T., Mohamed, W., Leeman, I., Pellowe, C., Kunst, G., Klein, A. and Murphy, G.J., 2022. Role of hypothermia in adult cardiac surgery patients: a systematic review and meta-analysis. Journal of Cardiothoracic and Vascular Anesthesia, 36(7), pp.1883-1890. | |
| Rong, L.Q. and Gaudino, M., 2022. Hypothermia, Meta-Analyses and Reporting Bias: Nothing New Under the Sun. Journal of Cardiothoracic and Vascular Anesthesia, 36(7), pp.1891-1892. |
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2 thoughts on “Episode 187 Hypothermia Part 2: How it helps”
A sea cloak is also called a boat cloak, picture a heavy broadcloth cape that wraps around the body and drapes nearly to the floor. Very handy against a chill but easy to move swiftly in. Still an optional component of the modern USMC formal uniform.
You mentioned that cold is used during chemo to protect hair. During chemo for endometrial cancer, I was developing neuropathy on my hands & feet. To try to stop it getting worse, cold packs were used on my hands & feet during a chemo session, to halt further damage/exposure by the chemo drugs in those areas. I opted out of having cold packs used on my head to protect my hair – I lost it all by then.
I noticed that some weight loss clinics use cold somehow in targeted areas, to reduce weight. No clue if it’s valid.
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