Traumatic Brain Injury Battlefield and Intensive Care Rapid and Selective Cerebral Hypothermia Using an Integrated Head-Neck Stabilization and Cooling Helmet System
Authors: Wang Huan  , Elkins William  
Published: February 2025

Traumatic Brain Injury (TBI) has been called the &ldquo;signature wound&rdquo; of the Iraq and Afghanistan wars. Helmets help, but don&apos;t completely protect against the pressure shifts caused by explosives. Flying objects from explosives have caused other head injuries. More allied soldiers are battling TBI now than in any other war. Better protective equipment and emergency care has saved more lives. Of those surviving a blast, 59% have suffered TBI. TBI is often followed by Posttraumatic Stress Disorder (PTSD). It is well recognized that the application of cooling directly to the head and neck region can potentially have a profound favorable effect on the recovery of the patient. A successful pilot study by Dr. Huan Wang, Dr. William Olivero, and William Elkins was conducted in 2001. Significant reduction in brain temperature in excess of 2&deg;C (3.9&deg;F) was achieved within 15 minutes of the application of the head cooling device. Core temperature was maintained at &ap;+2&deg;C over brain temperature. No device related complications were noted. Hypothermia is by far the most potent therapeutic neuro-protectant in laboratory studies. Although systemic (whole-body) hypothermia has demonstrated to provide significant neurological benefits in patients with pre-hospital cardiac arrests, its application in head trauma and stroke patients remains controversial. Systemic hypothermia has potentially severe complications that include arrhythmia, coagulopathy and infection. To minimize such systemic side effects induced by whole-body hypothermia, we have focused on techniques that could selectively cool the brain while maintaining the core body temperature in a safe range. Using National Aeronautics and Space (NASA) spin-off technology, we have developed a specialized integrated head-neck cooling and restraint system that allows optimal contact with the cranium and neck regions. In our pilot study involving severe head trauma and stroke patients, this device demonstrated both rapid and selective brain cooling. To maximize the therapeutic potential of selective cerebral hypothermia, ultra-early initiation of brain cooling in the field is necessary. This project is a prospective, controlled feasibility and safety study of applying a cooling head-neck liner integrated with head-neck stabilization and initiating selective cerebral hypothermia in brain injury patients in the field. This is an extension of a pilot study that we conducted in a clinical setting. The results we obtained from our clinical study demonstrated that we could rapidly lower the intracranial temperature to a hypothermic state while maintaining the body core temperature within a safe range. Our pilot study demonstrated that the cooling head cover was effective in rapidly achieving brain cooling and establishing a favorable brain-to-body temperature gradient. Our overall goal is to significantly improve the outcome of brain injured military personnel by rapidly inducing moderate cerebral (28-32&deg;C) hypothermia but mild systemic (32-35&deg;C) hypothermia to maximize the neuro-protective potentials yet minimize the systemic hypothermia induced complications.