Hypothermia ICP ALF — FRCA Final MCQ
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Correct answer: A — 34-35°C
In acute liver failure with raised ICP, moderate hypothermia (33-34°C, some centres target 34-35°C) can reduce ICP by decreasing cerebral metabolism and cerebral blood flow. This differs from TBI where the Eurotherm trial showed no benefit of hypothermia. In ALF, hypothermia is used as a bridge to liver transplantation. It also reduces ammonia-driven brain swelling. Complications include: coagulopathy (already impaired in ALF), infection risk, and arrhythmias. Temperature must be carefully monitored and rewarming performed slowly to avoid rebound ICP elevation.
Reference: AASLD – 2023 – Acute liver failure guidelines; RCOA – 2023 – Neuroanaesthesia in ALF