A Clinical Test for a Newly Developed Direct Brain Cooling System for the Injured Brain and Pattern of Cortical Brainwaves in Cooling, Noncooling, and Dead Brain Zamzuri Idris, MD, 1–3 Ang Song Yee, MD, 1,3 Wan Mohd Nazaruddin Wan Hassan, MD, 3,4 Mohd Hasyizan Hassan, MD, 3,4 Khairu Anuar Mohd Zain, BEng, 5 and Asrulnizam Abdul Manaf, PhD 5 To ensure the direct delivery of therapeutic hypothermia at a selected constant temperature to the injured brain, a newly innovated direct brain cooling system was constructed. The practicality, effectiveness, and safety of this system were clinically tested in our initial series of 14 patients with severe head injuries. The patients were randomized into two groups: direct brain cooling at 32°C and the control group. All of them received intracranial pressure (ICP), focal brain oxygenation, brain temperature, and direct cortical brain- wave monitoring. The direct brain cooling group did better in the Extended Glasgow Outcome Scale at the time of discharge and at 6 months after trauma. This could be owing to a trend in the monitored parameters; reduction in ICP, increment in cerebral perfusion pressure, optimal brain redox regulation, near-normal brain temperature, and lessening of epileptic-like brainwave activities are likely the reasons for better outcomes in the cooling group. Finally, this study depicts interesting cortical brainwaves during a transition time from being alive to dead. It is believed that the demonstrated cortical brainwaves follow the principles of quantum physics. Keywords: brain cooling, severe head injury, intracranial pressure, brainwaves, decompressive craniectomy, quantum brain Introduction T raumatic severe head injury is commonly associated with undesirable outcomes. This could be owing to complex pathophysiology underlying severely injured brain (Nortje and Menon, 2004; Polderman, 2004a; Jackson and Kochanek, 2019). The proposed pathophysiological mecha- nisms underlying head injury revealed several important abnormalities, including (1) the activation of caspase en- zymes; (2) the presence of mitochondrial dysfunction; (3) the increase in the local secretion of various vasoactive media- tors secreted by the endothelium and excitatory neurotrans- mitters, such as glutamate and free oxygen radicals; (4) the disorders of intracellular ion concentrations; (5) the over- expression of the inflammatory and immunological re- sponses; (6) the presence of epileptic activity; (7) the disruption in blood–brain barrier and presence of vascular permeability with pathological edema as well as brain swelling; (8) the abnormal microcirculatory brain circuits and presence of intra- and extracellular acidosis; and (9) the expression of immediate early genes and cold shock proteins. Despite the vast understanding of its basic pathophysiology, the removal of the surgical lesions, decompressive cra- niectomy, and intracranial pressure (ICP) management were the only options for clinicians in treating this complex dis- ease. However, Polderman (2004a) and recently Jackson and Kochanek (2019) have published a review article on this issue and highlighted the benefits of induced hypothermia on the injured brain. They argued that the true benefit of mild hy- pothermia lies in mitigating the aforementioned pathophys- iological responses of brain injury. A combination of vast understanding in basic pathophys- iology and the mounting evidence from animal studies that have reproducibly shown that mild hypothermia is pro- foundly neuroprotective has opened to several clinical trials for hypothermia in head injury (Luan et al., 2004; Ding et al., 1 Department of Neurosciences, and 2 Brain and Behaviour Cluster (BBC), School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia. 3 Hospital Universiti Sains Malaysia (HUSM), Universiti Sains Malaysia, Kubang Kerian, Malaysia. 4 Department of Anaesthesiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia. 5 Collaborative Microelectronic Design Excellence Center (CEDEC), Universiti Sains Malaysia, Bayan Lepas, Malaysia. THERAPEUTIC HYPOTHERMIA AND TEMPERATURE MANAGEMENT Volume 00, Number 00, 2021 ª Mary Ann Liebert, Inc. DOI: 10.1089/ther.2020.0033 1 Downloaded by 3.81.25.228 from www.liebertpub.com at 05/26/21. For personal use only.