Smash, just curious but do you have a reference for your claim about TH not working for neuro?
Sydenham E, Roberts I, Alderson P. Hypothermia for traumatic head injury. Cochrane Database of Systematic Reviews 2009, Issue 2.
The local HEMS program here did a trial using manatol for head injuries. I believe in their study it was statistically significant for slowing damage with increased ICP. I could see one of these osmosis drugs being used before prehospital TH for head injuries.
I would be interested to see this, as to the best of my knowledge there has never been any strong evidence for benefit from mannitol in the acutely head injured patient. If it is used at all it is just as a single bolus in the patient who is herniating.
Wakai A, Roberts IG, Schierhout G. Mannitol for acute traumatic brain injury. Cochrane Database of Systematic Reviews
2007, Issue 1
Mendelow AD, Teasdale GM, Russell T et al. Effect of mannitol on cerebral blood flow and cerebral perfusion pressure in human head injury. J Neurosurg 63:43-48, 1985
Muizelaar JP, Lutz HA, Becker DP et al. Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head injured patients. J Neurosurg 61:700-706, 1984
Rosner MJ, Coley I. Cerebral perfusion pressure: a hemodynamic mechanism of mannitol and the pre-mannitol hemogram. Neurosurg 21:147-156, 1987
Cruz J, Miner ME, Allen SJ et al. Continuous monitoring of cerebral oxygenation in acute brain injury: injection of mannitol during hyperventilation. J Neurosurg 73:725-730, 1990
Cold GE. Cerebral blood flow in acute head injury. Acta Neurochir S49:18-21, 1990
Kaufmann AM, Cardozo E. Aggravation of vasogenic cerebral edema by multiple dose mannitol. J Neurosurg 77:574-589, 1992
Schwartz ML, Tator CH, Rowed DW. The University of Toronto head injury treatment study: A prospective randomised comparison of pentobarbital and mannitol. Can J Neurol Sci 11:434-440, 1984
Smith HP, Kelly DL, McWhorter JM et al. Comparison of mannitol regimens in patients with severe head injury undergoing intracranial monitoring. J Neurosurg 65:820-824, 1986