Skip to Main Content


  • Induced hypothermia has been shown to reduce mortality when applied after resuscitation from cardiac arrest.
  • While the ideal temperature for hypothermia is not known, most experts believe that cooling to 32 to 34°C is optimal.
  • Induced hypothermia may have benefit for other disease processes such as myocardial infarction and stroke.
  • The mechanisms by which hypothermia acts are multifaceted and a focus of much current investigation.


The notion of cooling patients for medical benefit is quite old. In 1814, Baron Larrey, a French surgeon in the service of Napoleon's army, reflected on soldiers who suffered major injuries on the frozen battlefields in Russia by commenting that “cold acts on the living parts … the parts may remain … in a state of asphyxia without losing their life.”1 A belated resurgence of interest in hypothermia has taken place in the past decade, expanding the possible medical indications for its use. Induced hypothermia, the intentional lowering of body temperature, has been explored in a number of acute critical care settings, including myocardial infarction, stroke, head trauma, and after cardiac arrest. While the optimal depth and timing of hypothermia are not yet established for these uses, most experts advocate a temperature goal of 32 to 34°C because it seems to provide significant benefit while avoiding most of the adverse effects associated with the intervention. Timing of hypothermia, with respect to both time of induction and duration of therapy, is even more uncertain, although general consensus holds that cooling should be initiated as soon as possible after the morbid event and should be maintained for at least 12 to 24 hours. Regarding specific uses, there is particularly good evidence that hypothermia is protective for the resuscitated cardiac arrest patient after return of spontaneous circulation.2,3 The use of hypothermia in other clinical scenarios remains promising but less clear at present.


This chapter addresses elements of the history of hypothermia, the laboratory and clinical data that have developed our understanding of its use, some of the various techniques used to cool patients, and the clinical syndromes for which hypothermia appears to offer the greatest advantage.


The protective effects of hypothermia induction have been suggested since the time of Hippocrates, who advocated packing bleeding patients in snow.4 Hypothermic protection also was noted by Napoleon's battlefield surgeon, Baron Larrey, during the French invasion of Russia. He observed improved survival of injured soldiers left in the snow compared with those treated with warm blankets and heated drinks.1 Induced hypothermia has been studied in a wide variety of illnesses, both ischemic and nonischemic in nature (reviewed in refs. 5 through 7). These include traumatic brain injury,8–10 status epilepticus,11 arrhythmia, sepsis, and the ischemic illnesses of myocardial infarction, stroke, and cardiac arrest.7,12 Interestingly, the first reported use of induced hypothermia was in the setting of malignancy. In 1939, Fay and colleagues treated patients with metastatic carcinoma, with the ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.