Hypothermia is the most potent and most studied means of preventing and treating brain injury. The benefits of hypothermia were first recorded 5,000 years ago in Egypt, while Napoleon’s chief surgeon was the first to observe that injured soldiers who remained hypothermic were more likely to survive than those warmed by the fire. Experimental animal models have consistently shown that cooling the brain can reverse injury from stroke, cardiac arrest, shock and brain trauma. Unlike drugs, hypothermia readily crosses the blood-brain barrier and can extend into regions of the brain without blood flow. The potential of hypothermia is enormous.
Unfortunately, technical limitations have prevented the widespread application of cooling for brain injury. Slow brain cooling and side effects associated with cooling the body, inherent in all available hypothermia devices, have severely curtailed the therapeutic potential of hypothermia. Rapid application of hypothermia to the brain is critical, yet in a recent large European trial 10 hours were required to decrease brain temperature by 2C. Unwanted effects of body cooling can be severe and include death, bleeding, transfusion, infections, decreased wound healing, low blood pressure, myocardial infarction and prolonged hospital stay.
Dr. Kreck and the team at NeuroSave have developed a simple and easy to deploy means of cooling the brain while minimizing cooling of the body core. The NeuroSave device cools the blood prior to delivery to the brain by cooling the tissue along the full length of the carotid and vertebral arteries. The tissue surrounding these arteries is easily cooled by irrigating the pharynx and esophagus with chilled saline, without breaking the skin. In a clinical feasibility trial the NeuroSave device was able to cool the brain 3C in 15 minutes and maintain the body 3.5C warmer than the brain. The unique location of heat exchange utilized by the NeuroSave device allows for enhanced brain cooling when blood flow to the brain is reduced, when brain cooling is most needed. The speed and selectivity of the NeuroSave device is unmatched by any existing technology.
Engineering a better heat exchanger, by utilizing basic anatomic relationships, has resulted in a uniquely powerful treatment for the most complex and irreplaceable organ in the body. Critical problems in modern medical care may still be addressed with the application of straightforward engineering principles.
About the Presenter:
Thomas Kreck, MD is the Chief Medical Officer and co-founder of NeuroSave Inc., a medical device company based in San Francisco. Tom is a critical care specialist and pulmonologist with a background in electrical engineering.
Tom practiced for 12 years at Kaiser-Permanente. He completed his pulmonary/critical care fellowship and post-doctoral work at University of Washington (Seattle, WA), where he developed a novel method of functional lung imaging of regional ventilation and perfusion. He also developed systems to treat carbon monoxide poisoning that did not require access to hyperbaric therapy. Tom attended Robert Wood Johnson Medical School (New Briunswick, NJ) and Villanova University.
This is Dr. Kreck’s second presentation to this forum. His previous presentation highlighted a variety of ongoing needs in the critical care setting.