Highlights from the 7th International
Hypothermia and Temperature
Management Symposium in Sydney
By Andrew Cheng, MD
How do you measure
neurological outcome after
acute brain injury? What is
the optimal dose and duration
of targeted temperature
management after cardiac
arrest? How does this differ in
traumatic brain injury? And how
can this be best measured and
monitored in the neuro-ICU?
These were among some of the
questions posed, discussed and
debated at the recent seventh
and Temperature Management
Symposium, held in Sydney,
Australia, from Aug. 28-30, 2018.
A biennial conference organized by scientific experts in the field
of targeted temperature management (TTM) in emergency and
critical care medicine, the symposium has its foundations in Japan
when the inaugural meeting was held in Tokyo in 2004, organized
by professor Nariyuki Hayashi. Subsequent meetings have been
held in Miami (chair Dalton Dietrich), Lund, Sweden (co-chairs
Hans Friberg and Taduesz Wieloch), Tokyo (chair Ken Nagao),
Edinburgh, Scotland (chair Peter Andrews) and Philadelphia (cochairs
The Sofitel Darling Harbour, next to the new Sydney International Convention Centre and Sydney Aquarium,
provided the setting for the seventh International Hypothermia and Temperature Management Symposium.
Fred Rincon and David Gaeski).
Chaired by Manoj Saxena and Naomi Hammond, with major
academic sponsorship by The George Institute for Global Health
and the University of New South Wales, this symposium focused
on recent advances in the field of temperature management
related to basic science, clinical research and innovative
technology with the objective of translating contemporary
scientific knowledge into a practical message that can be applied
to everyday clinical practice. Highlights included the plenary
sessions given by professors Alistair Gunn (Auckland, New
Zealand), Peter Andrews and Dalton Dietrich.
Following an outstanding exposition of the preclinical foundations
of therapeutic hypothermia, professor Gunn proceeded in his next
lecture to demonstrate how hypothermia has shown significant
impact on improving outcomes after neonatal birth asphyxia. A
paediatrician scientist who has conducted groundbreaking basic
research on the mechanisms and treatment of asphyxial brain
injury, professor Gunn helped to develop a range of novel, clinically
relevant fetal sheep paradigms with research that helped to establish
the technique of “therapeutic cooling” to reduce brain injury due to
low oxygen levels at birth.
Professor Andrews presented his plenary on the future of
hypothermia for traumatic intracranial hypertension after Eurotherm.
This was a particularly important discussion in light of the all the
recent clinical trials of therapeutic hypothermia in traumatic brain
injury (TBI) that have failed to demonstrate a positive impact of
temperature management—despite decades of basic science research
that have demonstrated the effects of even small variations in
temperature on neuronal vulnerability and the negative impact of
fever on neurological outcome after acute brain injury.
Professor Dietrich, who is editor-in-chief of the Therapeutic
Hypothermia and Temperature Management journal and one of
the founding chairs of the IHTMS, shared in his plenary some
of the research work he and his team have conducted on the
effects of brain temperature on inflammation and the cerebral
vasculature in mild TBI (or concussion) work, which had recently
been acknowledged in the form of a $1.6M grant by the National
Insititute of Health (NIH) and National Institute of Neurological
Disorders and Stroke (NINDS).
New themes introduced at this symposium included the emerging
role of extracorporeal membrane oxygenation (ECMO) and
advanced multimodality monitoring, not only to monitor
neurological recovery of the patient but to refine the delivery
of TTM and improve our understanding of the neurobiological
processes that take place during temperature management.
Sessions on ECMO included presentation of the Australian ECMOCPR
study by Andrew Udy (Melbourne, Australia), while Tetsuya
Panel discussion, chaired by Manoj Saxena and patient advocate
Nyrie Simpson, on measuring outcomes—what really matters?