European Stroke Organisation (ESO) Guidelines for the Management of Temperature in Patients with Acute Ischemic Stroke

Abstract

Background Hyperthermia is a frequent complication in patients with acute ischemic stroke. On the other hand, therapeutically induced hypothermia has shown promising potential in animal models of focal cerebral ischemia. This Guideline Document presents the European Stroke Organisation guidelines for the management of temperature in patients with acute ischemic stroke. Methods A multidisciplinary group identified related questions and developed its recommendations based on evidence from randomized controlled trials elaborating the Grading of Recommendations Assessment, Development, and Evaluation approach. This Guideline Document was reviewed within the European Stroke Organisation and externally and was approved by the European Stroke Organisation Guidelines Committee and the European Stroke Organisation Executive Committee. Results We found low‐quality evidence, and therefore, we cannot make any recommendation for treating hyperthermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and hyperthermia; moderate evidence to suggest against routine prevention of hyperthermia with antipyretics as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and normothermia; very low‐quality evidence to suggest against routine induction of hypothermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke. Conclusions The currently available data about the management of temperature in patients with acute ischemic stroke are limited, and the strengths of the recommendations are therefore weak. We call for new randomized controlled trials as well as recruitment of eligible patients to ongoing randomized controlled trials to allow for better‐informed recommendations in the future.

Zaburzenia termoregulacji pochodzenia ośrodkowego — jak diagnozować i leczyć

“…Hyperthermia is a common complication of AIS occurring in up to 50% of patients and is associated with a poorer prognosis [19]. The processes determining the brain temperature in AIS have not been fully elucidated [20,21].…”

“…Moderate hypothermia (32-33 o C), as opposed to mild hypothermia (34-35 o C), seems to lead to complications more commonly (hypotension, cardiac arrhythmias, pneumonia or thrombocytopenia) [45]. Likewise, the European Stroke Organisation does not recommend induced hypothermia as a measure either to improve the functional status or to lengthen the survival of AIS patients [19]. Moreover, there is no explicit answer to the question regarding temperature reductions in stroke patients; some issues are still unclear, i.e.…”

Targeted temperature management in the ICU: guidelines from a French expert panel

“…The meta-analysis of Ntaios et al [102] that included 4 major randomized trials [103–106] found no difference in mortality or neurological outcome between hypothermia and hyperthermia (>38 °C).…”

Evolving Treatments for Acute Ischemic Stroke

“…126 Hypothermia, a proven multimodal, effective physical approach to cytoprotection needs to be retested in this model. 127 Although there are no currently accepted adjuvant pharmacological treatments for acute stroke currently, this is a future blank-slate area for clinical research.…”