Targeted Temperature Management for Subarachnoid Hemorrhage: Excellent Outcome After Severe Vasospasm—A Case Series

Mäder, Lisa; A.M.Ganai,; Aroyo, Ilia; Schill, Josef; Tröscher-Weber, Regina; Huppert, Peter; Kotterer, O.; Geletneky, Karsten; Kollmar, Rainer

doi:10.1089/ther.2018.0049

Cited by 6 publications

(2 citation statements)

References 21 publications

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“…6,7 To date, there have been several reports on TTM for SAH. TTM at 33 to 35 °C has been indicated for good-grade SAH during operation, 17 poor-grade SAH (Hunt and Hess grade IV and V) and refractory intracranial hypertension, cerebral vasospasm, 18 intracranial hypertension and DCI, 19,20 vasospasm and DCI, 21 and poor-grade SAH (Japan Coma Scale score of 100 or higher, or Hunt and Hess grade IV and V) after surgery, 22,23 with some of these studies reporting potential benefits. [19][20][21]23 Our approach differs from those in previous reports in that we initiated cooling only for patients with WFNS grade V in the hyperacute phase before aneurysm treatment to mitigate, if possible, progressive EBI.…”

Section: Discussionmentioning

confidence: 99%

Targeted Temperature Management for Severe Subarachnoid Hemorrhage Using Endovascular and Surface Cooling Systems: A Nonrandomized Interventional Study Using Historical Control

et al. 2022

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BACKGROUND: Although targeted temperature management (TTM) may mitigate brain injury for severe subarachnoid hemorrhage (SAH), rebound fever correlates with poor outcomes. OBJECTIVE: To study the effect of endovascular TTM after rewarming from initial surface cooling during a high-risk period for delayed cerebral ischemia. METHODS: We studied patients with World Federation of Neurological Surgeons grade V SAH before and after the introduction of endovascular TTM. Both groups (36 patients each) were treated with TTM at 34 °C with conventional surface cooling immediately after SAH diagnosis, together with emergency aneurysm repair. When rewarmed to 36 °C, around 7 days later, the study group underwent TTM at 36 to 38 °C for 7 days with an endovascular cooling system. The control group was treated with antipyretics. RESULTS: Sex, age, Glasgow Coma Scale score, modified Fisher computed tomography classification, aneurysm location, and treatment methods were not different between the study and control groups. Differences were detected in the incidence of fever >38 °C (13 vs 26 patients, P = .0021), duration of fever >38 °C (4.1 vs 18.8 hours, P = .0021), incidence of vasospasm-related cerebral infarction (17% vs 42%, P = .037), and the likelihood of excellent outcomes (0 and 1 on a modified Rankin Scale) at 6 months (42% vs 17%, P = .037). In endovascular TTM, shivering occurred more frequently in patients with better outcomes, requiring aggressive treatment to avoid fever. CONCLUSION: Endovascular TTM at 36 to 38 °C after surface cooling was feasible and safely performed in patients with severe SAH. Combined TTM for 2 weeks was associated with a lower incidence of vasospasm-related infarction and may improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Targeted Temperature Management for Severe Subarachnoid Hemorrhage Using Endovascular and Surface Cooling Systems: A Nonrandomized Interventional Study Using Historical Control

et al. 2022

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“…Rewarming was carried out slowly with the goal of not increasing the maximal temperature by >0.5°C in a 24-hour period (Kuramatsu et al , 2015 ; Mader, 2019 ). Rewarming was usually carried out over 3 or 4 days using a WarmTouch™ (Model 6000; Covidien, Mansfield, MA, USA) or a Bair Hugger warming device (Model 505/10; Augustine Medical, Inc., Eden Prairie, MN, USA) (Wang et al , 2022 ).…”

Section: Methodsmentioning

confidence: 99%

Early and Prolonged Mild Hypothermia in Patients with Poor-Grade Subarachnoid Hemorrhage: A Pilot Study

Rhim

Park

Kim

et al. 2022

Therapeutic Hypothermia and Temperature Management

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We assessed the feasibility of therapeutic early and prolonged mild hypothermia (MH) in patients with poor-grade subarachnoid hemorrhage (SAH). A retrospective pilot study was conducted for poor-grade SAH patients at two university hospitals from March 2015 to December 2018 who had received MH immediately after coil embolization and maintained a target temperature of 34–35°C for 5 days. A matched controlled design at a 1:2 ratio was used to compare MH therapy outcomes. The primary goal was to assess the two groups' severe functional outcomes at discharge defined as a modified Rankin Scale score of 4–6. The secondary aim was to assess mortality and severe vasospasm depending upon MH. A binary logistic regression analysis was performed to identify relevant risk factors for the outcomes. A total of 54 patients (18 with MH treatment and 36 without MH treatment) were included. Severe functional outcome was significantly decreased in poor-grade SAH patients with MH ( n = 7, 38.9%) than those without MH ( n = 25, 69.4%; p = 0.031). In patients treated with MH, mortality and severe vasospasm tended to be less common, although the difference was not statistically significant. A binary logistic regression analysis revealed that early and prolonged MH (odds ratio [OR] = 0.156, 95% confidence intervals [CI]: 0.037–0.644) and severe vasospasm (OR = 5.593, 95% CI: 1.372–22.812) were risk factors for severe functional outcomes. This study shows potential therapeutic effect of early and prolonged MH treatment in poor-grade SAH patients. A randomized controlled study with a large number of patients is warranted in the future.

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Aneurysmal subarachnoid hemorrhage during pregnancy: a comprehensive and systematic review of the literature

et al. 2021

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Targeted Temperature Management for Subarachnoid Hemorrhage: Excellent Outcome After Severe Vasospasm—A Case Series

Cited by 6 publications

References 21 publications

Targeted Temperature Management for Severe Subarachnoid Hemorrhage Using Endovascular and Surface Cooling Systems: A Nonrandomized Interventional Study Using Historical Control

Targeted Temperature Management for Severe Subarachnoid Hemorrhage Using Endovascular and Surface Cooling Systems: A Nonrandomized Interventional Study Using Historical Control

Early and Prolonged Mild Hypothermia in Patients with Poor-Grade Subarachnoid Hemorrhage: A Pilot Study

Aneurysmal subarachnoid hemorrhage during pregnancy: a comprehensive and systematic review of the literature

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