Thermahelm Motorcycle Helmet Cools Head Upon Impact

Ok, whomever wtote this artice needs some medical school training. "Exothermic" is hot and endothermic is COLD. The new helmet aims to COOL not heat the brain. Also, is is not designed to induce a hypothermic state, is is designed to entend the critical Golden Hour pre-hospital admisson.

It cannot be aruged that ANY and I mean ANY bruised or injuered tissue benefits from cold and the long term damage is far lessoned.

There ARE studies to prove this (if you really need medical edification so badly that you don't know that brain cooling is used routinely in one in 5 TBI cases in the Emergency Room).
EUROTHERM3235 Trial is one such difinitive study underway now. Needless to say, if any sensible person were laying out-cold after a nasty accident, they would far prefer that a cold compress is applied at the point of impact to prevent your bloodways from flattening and starving your brain of oxygen because of the swelling. What silly comments above on a tecnology that has been vetted by the British Govenment. Glad you are not a doctor in chage of patients!

The exo/endothermic mistake has been fixed.

M. Kostkova,

It's Sean, author of this post. Thank you for your criticism and I appreciate you offering me the opportunity to help clarify this post. The exo vs. endothermic mistake was simply an oversight and has been corrected. As for the rest of the post, my comments stated that I think the Thermahelm website is poorly representing the data to support the benefit of their helmet, not that the device may not actually be beneficial. The Thermahelm helmet is indeed a neat idea and who knows, might turn out to be a fantastic addition to motorcycle safety.

My problem is that the claim that the helmet will save lives is not proven and the study they cite as evidence that their helmet will lead to better TBI outcomes is from a meta-analysis review article (see The Journal of Neurotrauma) that looks at outcomes from full-body cooling rather than acute, local cooling like the helmet would provide. And even it were not such a stretch to use this study to support the benefit of Thermahelm, the cited meta-analysis found a benefit for outcomes only for patients cooled over 48 hours (RR .51 with [.33 to .79] 95% CI for mortality outcome and RR1.91 with [1.28 to 2.85] 95% CI for good neurological outcomes). For patients cooled less than 48hrs, they did not see these benefits. In addition, the study showed greater pneumonia (by about a factor of 2) in patients who received cooling for TBI.

Thank you for also pointing out the Eurotherm3235 trial. I read about this particular trial prior to posting and noticed that the involvement criteria for theresearch protocol requires patients to be cooled less than or equal to 72 hours from their initial head injury. The trial does not investigate the benefit of immediate cooling on traumatic head injuries.

That being said, I agree that it does make intuitive sense to cool the head immediately after impact, but that does not necessarily mean the data is there to support the claim that the helmet will "save lives." If you know of any clinical studies that show outcome improvements of TBI as a result of immediate cooling of the head, certainly let me know and I'm happy to append this post. I also did some research into emergency medical technician procedure for traumatic head injuries and did not find any resources to show that it is protocol to immediately ice a traumatic head injury upon arrival to the scene.

Lastly, I thought the golden hour you mentioned generally referred to heart attacks.

Cheers,
Sean

Dear Sean,

Thank you for your response.

In rebuttal: The ThermaHelm site has animation See: http://www.thermahelm.com/cooling-helmet-technology and this animation clearly shows that the device is aimed to maintain a normothermic state of 37C, not hypothermic of 33-35C. To do this, they need to use an endothermic chemical reaction and I am pretty sure they have got it spot on. They have used data on brain cooling as a guide to the science behind the very concept of cooling the brain as viable and beneficial. As it certainly cannot hurt the accident victim, and in fact may actually do some good, such technologies should not be shot down in the first instance as doing so jeopardises all university-based spatial thinking.

I do hope you amend your post and feel free to remove my comments once you have done so.

I quote: "The endothermic reaction is immediate and cools the brain through small veins in the scalp called emissary capillaries. As the reaction is progressive, heat from the head will be continually absorbed.
The cooling process lasts approximately 30-45 minutes and will maintain stable brain temperatures during this time. A hot and expanded brain flattens the blood ways, starving the brain tissue of vital oxygen. If the brain's temperature can be stabilised, the accident victim is much more likely to avoid Traumatic Brain Injury and so increase his/her chances of survival." I agree with this statement.

It makes a biologically plausible claim based on in-vitro and indeed some in-vivo evidence. I am sure doctors would agree that at the very least there is a breadth of 'circumstantial evidence' to support the 'hypothesis'. It is true that as a practical claim there can be no direct experimental evidence, since this would involve crashing real motorcyclists heads in helmets with and without the brain cooling device to provoke TBI, until one had determined whether outcomes for those with the device bettered those without. Obviously this is highly unethical, and is a recurring problem in medicine, be it during the introduction of other technologies in live-saving situations, or new treatments for cancer - their introduction proceeds on the basis of high plausibility for a benefit and a recognition of a high level of need for improvement. I believe this is one such area?

One of the practical hopes for the Thermahelm therefore might be that through its use 'in the field', it finally provides this direct evidence for early brain cooling in TBI, that is at present ethically unobtainable. The most Thermahelm, its users and those of us observing it in usage can insist upon of this device is that it performs as well as any other helmet design in providing conventional protection, and that its cooling effects are not actively harmful. Positive benefits then seen beyond this will become quantifiable over time, and the additional cost aside, there is simply no obvious 'down-side' to a Thermahelm helmet to the end user.

One doctor had the following to say:

"It has been proven that the uncritical (ie, to everyone) application of cooling to patients with head injuries has no benefit."

Now I am going to be obtuse, since with this statement, the devil is in the details: What research paper does this relate to I wonder, because ...I am unsure whether this statement is saying that the harm done to some by brain cooling EXACTLY cancels the benefit seen in others (how unlikely!), or as is more likely given the nature of statistical analyses that: a relative minority will have benefited, while the majority did not, and in the ensuing statistical analysis the 'random noise' of the majority drowned out the benefits seen to the minority.

Note that this is not the same as saying no-one benefits, or saying that any came to any harm.

In particular from a practical point of view, if you did find yourself as a motorcyclist in that minority, you could not then benefit from what you didn't have, if you were not wearing a brain-cooling helmet.

What presumably one WOULD wish to know is that 1) the helmet works as well in a conventional sense as a conventional helmet, and 2) that the activation of the brain cooling device will not cause any positive harm - and I believe these are both testable, and have been tested in refining this helmet's design.

"It is sometimes used in selected areas that don't respond to other measures"
True.

But surely this is a disingenuous statement, in that is not providing a counter-argument against brain cooling. Rather, again, it makes the point that there IS some evidence for it. Equally, the idea that this evidence is only derived from those circumstances where other measures have already failed should not imply that this is brain cooling's only potential role. For example sedation as a treatment (see below), unless due to TBI (A reduced GCS) is not immediately available at the roadside.

You're far more likely to die at the roadside from a blocked airway than swelling of the brain

True. But if you survive this, only to be concurrently maimed by an evolving brain injury, that's a bit of a shame!

Maybe some mileage in this if ambulances took TBI cases directly to neuro ICU

Optimising the rest of the chain of survival is of course beyond the remit of a brain cooling helmet

Of the 100 severe head injuries I see each year, around 20% require cooling.

The number needed to treat is therefore one in five, which vastly better than the majority of medicines we currently prescribe, for example (statins have a NNT of >6). If you gave your average motorcyclist a one in five chance to improve their chances of living with an improved helmet, how many would not take it? And should we be actively telling them not to take it, which seems to be the current prejudice?

If every brain was cooled before getting to me, I'd say I could probably use that money better somewhere else.

Again, this is something of an irrelevant statement. This doctor may wish that motorcyclists made donations to the funding of his department, but the quite separate issue is whether privately paying motorcyclists wish to invest in a device that has a chance to save their lives.

The obvious analogy here I feel would be with airbags in cars. Often they will not be needed (wrong sort of impact), or indeed ineffective (over-powered by the kinetic energy of the collision, or the patient dies from an unrelated injury), but are you going to leave them out on the basis that they won't help everyone?

It's rather pointless when the first thing the ambulance medics will do at the roadside is take your helmet off to ensure the airways are clear.

It is obvious that ambulance response times will vary. All sorts of unpredictable needs such as to close a road, or the clearance of hazards, can substantially slow the delivery of active care to an injured motorcyclist. The window of opportunity for the helmet cannot therefore be assumed to be negligible, which seems to be this statement's implication.

Again, the success of the onward chain of survival in maintaining brain cooling once established by the helmet is clearly beyond the remit of the Thermahelm device.

In the neurology ICU I follow this protocol:
Pressure monitor is used in ICU, always scanning the brain first.
If pressure reaches the point at which oxygen and blood can't get in, sedation is used to alleviate pressure by reducing activity in the brain.
Only then do I consider cooling (to 34C).

Again I cannot see that this statement provides any directly useful information? It perhaps serves to illustrate how limited existing options for managing TBI are. It is therefore simply a statement of current practice. These of course should evolve over time, driven by research and technological advances. It is true that some advances might ultimately be unfruitful, but equally there are many examples of the inertia of medical dogma slowing progress on this basis I would suggest any arguments about best practice with regards to Thermahelm at present time are moot. Time will tell, and as long as the helmet does no harm, then there is no harm, and possible benefit, to its adoption.

Dean, Can you please remove the duplicate post and change all the � to quotation marks as they were originally?

Also, the inventor is Jullian Powers and his full name is actually full name Jullian Preston-Powers from ThermaHelm - not the Scottish PhD student to whom this invention was credited.