Feasibility of hypothermia beyond 3weeks in severe ischemic stroke

Mourand, Isabelle; Escuret, E; Héroum, C.; Jonquet, O.; Picot, Marie‐Christine; Mercier, Grégoire; Milhaud, D.

doi:10.1016/j.jns.2012.01.014

Cited by 7 publications

(8 citation statements)

References 33 publications

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“…Based on the concept, that maximum edema occurs usually between days 2 and 4, cooling in the hypothermia cohort was intended for 96–120 h. In earlier cohorts and a controlled trial, hypothermia was conducted for 24–116 h, but mainly for 48–72 h. 15,21 Longer durations of hypothermia for patients with severe stroke were prospectively assessed in a small cohort. 17 However, the optimal duration of hypothermia needs to be evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…Few reports are available on the combined approach of hypothermia and hemicraniectomy. 15–17 In one randomized, controlled study, patients were treated with hemicraniectomy alone (n = 13) or with hemicraniectomy and mild hypothermia (35°C; n = 12). 15 For patients with the combined treatment, no additional side effects and a trend for improved functional outcome after six months were observed.…”

Section: Introductionmentioning

confidence: 99%

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No benefits of hypothermia in patients treated with hemicraniectomy for large ischemic stroke

Schneider

Krüger

Algra

et al. 2017

International Journal of Stroke

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Background Space-occupying middle cerebral artery brain infarcts are associated with the development of brain edema, which may lead to cerebral herniation and death despite early hemicraniectomy. Aims To evaluate the benefit of therapeutic hypothermia in patients with space-occupying cerebral infarction treated with hemicraniectomy within 48 h of stroke onset. Methods Patients aged 18-60 years with space-occupying cerebral infarction treated with hemicraniectomy within 48 h and hypothermia (33-34°C) were selected from a single university hospital between 2001 and 2010 (n = 53). Patients treated with hemicraniectomy alone served as comparison group (n = 58), originating from three randomized controlled trials evaluating the effects of early decompressive surgery (DECIMAL, DESTINY, HAMLET). Primary outcome was the score on the modified Rankin scale at 12 months dichotomized between modified Rankin scale 0-3 and modified Rankin scale 4-6. Secondary outcome measures were modified Rankin scale score 0-4 and survival. Risk ratios were adjusted with Poisson regression. Results Mean patient age was 48 years. Median time from stroke onset to hemicraniectomy was 23.5 h in both treatment groups. Treatment with hypothermia had no effect on the primary outcome (modified Rankin scale 0-3 versus 4-6 (13/53 (25%) versus 24/58 (41%)); adjusted risk ratio 0.66, 95% confidence interval 0.38-1.13). Fewer patients treated with hypothermia had a modified Rankin scale score of 0-4 (21/53 (40%) versus 42/58 (72%); adjusted risk ratio 0.53, 95% confidence interval 0.37-0.76) and fewer patients survived (26/53 (49%) versus 46/58 (79%); adjusted risk ratio 0.60, 95% confidence interval 0.44-0.82). Conclusions In patients with space-occupying cerebral infarction, treatment with hypothermia had no additional benefit on functional outcome compared with treatment with hemicraniectomy alone.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

No benefits of hypothermia in patients treated with hemicraniectomy for large ischemic stroke

Schneider

Krüger

Algra

et al. 2017

International Journal of Stroke

View full text Add to dashboard Cite

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“…[9][10][11][12][13][14][15][16][17][18] However, its effects on mortality and neurological outcome remain unclear, especially in patients who cannot receive DC. Therefore, we conducted a RCT to address this issue.…”

Section: February 2016mentioning

confidence: 99%

“…However, the safety of mild hypothermia in patients with MCHI had been confirmed by many studies. [9][10][11][12][13][14][15][16][17][18] The complications associated with hypothermia included pneumonia, hyperglycemia, electrolyte disorders, and arrhythmia, among others. 39 However, no significant differences with normothermia treatment were recorded.…”

Section: Strokementioning

confidence: 99%

Improved Neurological Outcome With Mild Hypothermia in Surviving Patients With Massive Cerebral Hemispheric Infarction

Liu

Zhang

et al. 2016

Stroke

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Background and Purpose-We conducted this randomized controlled trial to investigate the effects of therapeutic hypothermia on mortality and neurological outcome in patients with massive cerebral hemispheric infarction. Methods-Patients within 48 hours of symptom onset were randomized to either a hypothermia group or a control group.Patients in the hypothermia group were given standard medical treatment plus endovascular hypothermia with a target temperature of 33 or 34°C. Hypothermia was maintained for a minimum of 24 hours. Patients in the control group were given standard medical treatment only with a target temperature of normothermia. The primary end points were mortality and the modified Rankin Scale score at 6 months. Results-There were 16 patients in the hypothermia group and 17 patients in the control group. At 6 months, 8 patients had died in the hypothermia group versus 7 patients in the control group (P=0.732). The main cause of death was fatal herniation caused by a pronounced rise in intracranial pressure. Seven patients (43.8%) had a modified Rankin Scale of 1 to 3 in the hypothermia group versus 4 patients (23.5%) in the control group (P=0.282). Additionally, of the survivors, patients in the hypothermia group achieved better neurological outcomes compared with those in the control group (7/8, 87.5% versus 4/10, 40.0%; P=0.066; odds ratio=10.5; 95% confidence interval, 0.9-121.4). Conclusions-Mild

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“…There are three studies reporting data on the combined approach of DHC plus TH (19–21). Only one of these studies reported outcome data comparing DHC plus mild TH (35°C) for two-days with DHC alone in a prospective, randomized, controlled fashion.…”

Section: Introduction and Rationalementioning

confidence: 99%

DEcompressive Surgery plus hypoTHermia for Space-Occupying Stroke (DEPTH-SOS): A Protocol of a Multicenter Randomized Controlled Clinical Trial and a Literature Review

Neugebauer

Kollmar

Niesen

et al. 2013

International Journal of Stroke

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Feasibility of hypothermia beyond 3weeks in severe ischemic stroke

Cited by 7 publications

References 33 publications

No benefits of hypothermia in patients treated with hemicraniectomy for large ischemic stroke

No benefits of hypothermia in patients treated with hemicraniectomy for large ischemic stroke

Improved Neurological Outcome With Mild Hypothermia in Surviving Patients With Massive Cerebral Hemispheric Infarction

DEcompressive Surgery plus hypoTHermia for Space-Occupying Stroke (DEPTH-SOS): A Protocol of a Multicenter Randomized Controlled Clinical Trial and a Literature Review

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