Doctors move forward on research on brain cooling

Doctors move forward on research on brain cooling

URBANA -- When Dr. John Wang was a neurosurgeon in training, he noticed an interesting connection between his patients' temperatures and their conditions:

People tended to do better in the morning when their temperatures were lower, than in the evening when their temperatures would rise.

He began to consider the therapeutic effects of cooling specifically on the brain, which is sensitive to temperature changes and whether a cooler brain temperature would benefit patients in those critical hours following a traumatic head injury or stroke.

"It came to me so clear," Wang recalls. "I thought I was the brightest star under the sun. Then I learned that everybody is trying to cool."

The challenge to brain cooling, he soon learned, was finding a way to safely lower the brain temperature without also lowering the body temperature too much, creating potentially dangerous consequences to the heart and immune system and raising the risk of bleeding and infection.

Wang went looking for a solution and found one: a cooling helmet using NASA spin-off technology.

He also found the technology developer, former NASA scientist William Elkins, and began collaborating with him.

Wang, Elkins, and fellow researchers at the University of Illinois College of Medicine at Peoria conducted a study using Elkins' cooling helmet on severe head trauma and stroke patients, and published their findings in 2004.

Now Wang and fellow neurosurgeon Dr. William Olivero, who was also involved in the Peoria study, are poised to put brain cooling to a new test on patients in East Central Illinois.

Wang and Olivero, currently at Carle in Urbana, are undertaking a 12-month research project that will test the cooling head cover on Carle head injury and stroke patients.

Their research, funded with a $700,000 U.S. Department of Defense grant, is tentatively set to start in June, and they will have Elkins on board again for technical support.

While the research published in 2004 showed it's possible to cool the brain and how that affects body temperature, Wang says, the next step will be to show how well the cooling helmet works in the realm of emergency medicine.

Basically, "can the paramedics do this in the field," he adds.

So the grant money will be used to equip Carle's air and ground ambulances with cooling head covers purchased through Elkins company and train paramedics to use them on traumatic head injury and stroke patients being transported to Carle's trauma center.

Wang said actually applying the head cover won't involve any complex extra steps for paramedics. In a preliminary run, getting it on the patient took about 90 seconds.

Cooling and our bodies

Athletes are generally familiar with the "RICE" (rest, ice, compression, elevation) approach to treating an injury that begins to swell.

In fact, most of us are likely to go the freezer and reach for the ice in the event of a sprain or a minor household accident, then go rest and elevate the arm or leg that hurts, maybe wrap it up in a bandage, too.

The cold from the ice reduces the swelling, inflammation and pain. Elevation and compression also help reduce swelling, and rest aids healing.

But how do you rest, elevate, compress and ice up an injured brain?

When someone has suffered a traumatic head injury, the brain begins to swell and the pressure in the skull builds rapidly, sometimes leading to death, Wang says.

Doctors can't put an injured brain to rest without inducing a coma a risky move that would be done only as a last resort, Wang says so cooling is a safer way to bring down the swelling and reduce the pressure.

Why can't an ordinary ice pack do the same thing for the brain that it can for a sprained ankle? Because the brain has a very high metabolism, Wang explains. It's the main control center of the body and generates a lot of heat.

So a mechanism that can actively draw heat away is required to cool it down, he adds.

However, drastic temperature reductions aren't required for brain cooling.

For brain cooling patients, Wang says the brain temperature will be around 92-93 degrees F, with the body temperature at about 95-96 degrees F.

Patients determined to have a severe brain injury will wear the head cover for 72 hours. The risks from prolonged cooling include skin injury similar to frostbite and a lowering of body temperature, but Wang said patients will be continuously monitored and the settings on the head cover adjusted to minimize the risks.

It's important to note that any brain injury or stroke is considered a primary injury that can cause death or disability, according to Wang.

But he is also hopeful that cooling can delay the secondary damage that often results from brain injury and stroke enough to lengthen the treatment window time for the patient.

Stroke, for example, is caused either by blockage or bleeding in a blood vessel delivering oxygen and nutrients to the brain.

In the case of the most common kind of stroke, caused by blood clots, fast treatment is critical because clot-busting medication called tPA (tissue plasminogen activator) to restore blood flow should be administered within three hours for maximum benefit.

This treatment can significantly reduce the effects of a stroke and permanent disability, but generally only 3 percent to 5 percent of stroke victims reach the hospital in time to be considered for it, according to the American Stroke Association.

Launching potential

Carle's cooling head cover is based on technology designed for outer space.

Space suit designer Elkins was inducted into the U.S Space Foundation's Technology Hall of Fame in 1993 for his work on liquid-cooled garments designed to protect Apollo astronauts from high temperatures on the moon.

Elkins has since been recognized for his work in hypothermia to treat multiple sclerosis patients and other innovations in science, industry and medicine, and one of his technology ventures includes a treatment system used in sports medicine that delivers intermittent compression and adjustable cold therapy.

Elkins says the war in Afghanistan has created a focus for the treatment of traumatic brain injury, but he and Wang see vast potential for brain cooling in medicine.

A head-cooling cap is already being used in neonatal intensive care units to treat decreased blood flow and oxygen to the brains of tiny newborns, a condition that can otherwise cause seizures, cerebral palsy and cognitive issues. Carle's NICU has this cooling cap available.

And how about a brain-cooling motorcycle helmet that would act like an ice pack upon impact in the event of a crash? ThermaHelm, a British company, is selling one. (Wang's 2004 research is cited on the company's website at http://www.thermahelm.com.)

Football players also bang their heads a lot. Wang says he is in the initial phase of launching a new study at the UI involving college football players, to see if brain cooling will mitigate the long-term impacts of head injuries.

"There's a whole area of use for selective brain hypothermia," Elkins says.

Some other conditions that may one day be treated by brain cooling, he adds: epilepsy, migraine, bipolar disorder and post-traumatic stress disorder.

Wang envisions the day when every household may have some kind of home version of a cooling head cover on hand for first aid.

Imagine: You've suffered a stroke or a head injury at home, and in those critical minutes that follow, you're lucky enough to have someone who can fetch the family cooling head cover and put it on your head so you get some brain cooling started while the ambulance is on the way.

"If the cooling cover is beneficial for head trauma and stroke, its use can be beyond our wildest imagination," Wang says.