Intraoperative mild hypothermia ameliorates postoperative cerebral blood flow impairment in patients with aneurysmal subarachnoid hemorrhage.

Karibe, Hiroyuki; Sato, Kiyotaka; Shimizu, Hiroaki; Tominaga, Teiji; Nagamine, Yoshihide; Koshu, Keiji; Fujiwara, Satoru; Yoshimoto, Takeshi

doi:10.3995/jstroke.22.447

Cited by 5 publications

(7 citation statements)

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“…A positive finding from our study is the reduced risk of vasospasm and DCI. Decreased DCI and vasospasm in TH group compared with control group has been described previously (6,14,38). The mortality at 1 month was higher in the control group and good-to-moderate functional outcomes were more frequent in the TH group at 3 months.…”

Section: Discussionsupporting

confidence: 68%

“…When and how TH is administered after hospital admission should also be considered. Treatment of SAH with TH has been mostly reported before and during intervention (5,6,12,22). However, patient with poor-grade SAH are at higher risk of re-bleeding compared to good-grade SAH (5).…”

Section: Discussionmentioning

confidence: 99%

“…However, hypothermia as a treatment for hemorrhagic stroke is not fully understood. There is limited experimental and clinical evidence that TH effectively improves the clinical outcome for patients with SAH, except for a reduction in intracranial pressure (5)(6)(7)(8)(9). Induced hypothermia during aneurysm surgery is currently not routinely recommended, but may be a possible option in patients with good-grade aneurysmal SAH (10).…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and Safety of Mild Therapeutic Hypothermia in Poor-Grade Subarachnoid Hemorrhage: A Prospective Pilot Study

Kwon¹

2017

Preprint

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Therapeutic hypothermia (TH) improves the neurological outcome in patients after cardiac arrest and neonatal hypoxic brain injury. We studied the safety and feasibility of mild TH in patients with poor-grade subarachnoid hemorrhage (SAH) after successful treatment. Patients were allocated randomly to either the TH group (34.5°C) or control group after successful clipping or coil embolization. Eleven patients received TH for 48 hours followed by 48 hours of slow rewarming. Vasospasm, delayed cerebral ischemia (DCI), functional outcome, mortality, and safety profiles were compared between groups. We enrolled 22 patients with poor-grade SAH (Hunt & Hess Scale 4, 5 and modified Fisher Scale 3, 4). In the TH group, 10 of 11 (90.9%) patients had a core body temperature of < 36°C for > 95% of the 48-hour treatment period. Fewer patients in the TH than control group (n = 11, each) had symptomatic vasospasms (18.1% vs. 36.4%, respectively) and DCI (36.3% vs. 45.6%, respectively), but these differences were not statistically significant. At 3 months, 54.5% of the TH group had a good-to-moderate functional outcome (0-3 on the modified Rankin Scale [mRS]) compared with 9.0% in the control group (P = 0.089). Mortality at 1 month was 36.3% in the control group compared with 0.0% in the TH group (P = 0.090). Mild TH is feasible and can be safely used in patients with poor-grade SAH. Additionally, it may reduce the risk of vasospasm and DCI, improving the functional outcomes and reducing mortality. A larger randomized controlled trial is warranted.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility and Safety of Mild Therapeutic Hypothermia in Poor-Grade Subarachnoid Hemorrhage: A Prospective Pilot Study

Kwon¹

2017

Preprint

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“…Hypothermia does not affect CBF during complete global ischemia (Busto et al, 1987;Jiang et al, 1994;Kil et al, 1996;Sonn et al, 2002;Sugimura et al, 1998); global ischemia reduces CBF to less than 5% of normal (Busto et al, 1987), making it unlikely that hypothermia would have a further significant effect on CBF. However, there are a wide range of findings on CBF after reperfusion in global ischemia: hypothermia increases (Jenkins et al, 2001;Jiang et al, 1994;Karibe et al, 2000), decreases (Huang et al, 1999;Mori et al, 1998), or has no effect on CBF (Baldwin et al, 1991;Hoffman and Thomas, 1996;Horiguchi et al, 2003;Kil et al, 1996;Sonn et al, 2002;Sugimura et al, 1998).…”

Section: Cerebral Blood Flowmentioning

confidence: 99%

General versus Specific Actions of Mild-Moderate Hypothermia in Attenuating Cerebral Ischemic Damage

Zhao

Steinberg

Sapolsky

2007

J Cereb Blood Flow Metab

155

135

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Mild or moderate hypothermia is generally thought to block all changes in signaling events that are detrimental to ischemic brain, including ATP depletion, glutamate release, Ca 2 + mobilization, anoxic depolarization, free radical generation, inflammation, blood-brain barrier permeability, necrotic, and apoptotic pathways. However, the effects and mechanisms of hypothermia are, in fact, variable. We emphasize that, even in the laboratory, hypothermic protection is limited. In certain models of permanent focal ischemia, hypothermia may not protect at all. In cases where hypothermia reduces infarct, some studies have overemphasized its ability to maintain cerebral blood flow and ATP levels, and to prevent anoxic depolarization, glutamate release during ischemia. Instead, hypothermia may protect against ischemia by regulating cascades that occur after reperfusion, including blood-brain barrier permeability and the changes in gene and protein expressions associated with necrotic and apoptotic pathways. Hypothermia not only blocks multiple damaging cascades after stroke, but also selectively upregulates some protective genes. However, most of these mechanisms are addressed in models with intraischemic hypothermia; much less information is available in models with postischemic hypothermia. Moreover, although it has been confirmed that mild hypothermia is clinically feasible for acute focal stroke treatment, no definite beneficial effect has been reported yet. This lack of clinical protection may result from suboptimal criteria for patient entrance into clinical trials. To facilitate clinical translation, future efforts in the laboratory should focus more on the protective mechanisms of postischemic hypothermia, as well as on the effects of sex, age and rewarming during reperfusion on hypothermic protection.

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“…The small studies by Karibe et al [93], and Hindman et al [94], observed improved CBF in the ipsilateral frontal cortex, lower frequency of neurological deterioration and a greater incidence of long-term good outcomes and concluded that intraoperative hypothermia can reduce severity of ischemia induced by temporary cerebral vessel occlusion. A large prospective multi-center trial, the IHAST2 (Intraoperative Hypothermia for Aneurysm Surgery Trial part 2), on 1001 patients with good-grade patients concluded that mild intraoperative hypothermia did not improve the neurologic outcome after craniotomy [95].…”

Section: Neurosurgerymentioning

confidence: 99%

Therapeutic Hypothermia

2005

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GİRİŞDünyada ve ülkemizde tüm ölüm nedenleri arasında kardiyovasküler nedenlere bağlı ölümler ilk sıradaki yerini korumaktadır. Amerikan Kalp Birliği'nin (AHA) 2009 verilerine göre Amerika' da her yıl yaklaşık 290.000 ölüm kardiyovasküler hastalıklar nedeniyle olmaktadır 1 . Kardiyopulmoner resüsitasyon uygulanan hastalarda spontan dolaşım sağlandıktan sonra karşılaşılan en önemli sorun nörolojik tablonun kötü seyretmesi ve buna bağlı prognozun bozulması, yaşam kalitesi ve hayat beklentisinin azalmasıdır. Amerika'da hastane dışında gelişen kardiyak arrestlerde mortalite oranı % 65-95 civarındadır. Hastane dışı kardiyak arrest sonrası sağkalım ve hastaneden çıkma oranı %5 iken; eğer hasta yoğun bakım takibine alınmış ise bu oran %25-40' a çıkmaktadır. Sağ kalanlarda nörolojik sekelsiz iyileşme oranı ise %10-20 gibi düşük düzeylerdedir 2 . Resüsitasyonda hipoterminin bugün bu kadar üzerinde durulan bir konu olmasının sebebi resüsitasyon sonrasında hastaların nörolojik olarak sekelsiz iyileşmelerini sağlamak, yaşam beklentisini ve hayat kalitesini yükseltmeye çalışmaktır. Çünkü hipotermi; kardiyak arrest sonrasında reperfüzyon hasarı ile birlikte ortaya çıkan bir takım kimyasal reaksiyonları önlemede ve serebral metabolik aktivitenin baskılanmasında etkin bir yöntem olarak önerilmektedir 3 . Kardiyopulmoner resüsitasyon uygulandıktan sonra spontan dolaşım sağlanan, uygun endikasyonu olan hastalara, nörolojik geri dönüşün başarılı olmasını sağlamak için ilk 4-6 saat

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Intraoperative mild hypothermia ameliorates postoperative cerebral blood flow impairment in patients with aneurysmal subarachnoid hemorrhage.

Cited by 5 publications

References 0 publications

Feasibility and Safety of Mild Therapeutic Hypothermia in Poor-Grade Subarachnoid Hemorrhage: A Prospective Pilot Study

Feasibility and Safety of Mild Therapeutic Hypothermia in Poor-Grade Subarachnoid Hemorrhage: A Prospective Pilot Study

General versus Specific Actions of Mild-Moderate Hypothermia in Attenuating Cerebral Ischemic Damage

Therapeutic Hypothermia

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