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

Abstract

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

Regulation of therapeutic hypothermia on inflammatory cytokines, microglia polarization, migration and functional recovery after ischemic stroke in mice

“…Accumulating and compelling evidence has endorsed that TH is a promising therapeutic strategy after cardiac arrest and likely for brain injuries including stroke and TBI (Dietrich and Bramlett, 2010; Piironen et al, 2014; Su et al, 2016; Xiao et al, 2013). The cellular mechanism of the TH protection can be multifaceted, such as reduced death of multiple cells involving necrosis, apoptosis and autophagy, and prevention of brain edema and BBB damage.…”

5-HT1a activation in PO/AH area induces therapeutic hypothermia in a rat model of intracerebral hemorrhage

“…Moreover, the neuro-inflammation was tightly linked to increased local temperature, which indicates that early cooling measures represent a promising treatment for early brain injury [ 33 ]. However, when therapeutic hypothermia was transformed from bench to bedside, no difference or even higher mortality rates were identified in hypothermia-treated group in recent randomized trials [ 10 , 11 ].…”

“…Therapeutic hypothermia could be achieved via surface, intravascular or pharmacological routes, among which physical cooling was the most extensively used one in clinical practices [ 8 ]. Unfortunately, most of previous multi-center randomized clinical trials failed to verify the neuroprotective effect of physical hypothermia (PH) for ICH [ 9 - 11 ]. These successive failures are likely due to the side-effects of exogenous cooling methods [ 12 ].…”

“…The vigorous thermo-regulatory defense including shivering would be triggered by the exogenous cooling process and elicits a systemic stress reaction, which could lead to insufficient blood supply to the lesion area [ 13 ]. Furthermore, the rapid increase in intracranial pressure (ICP) during the rewarming process may also contribute to the failure of PH for ICH [ 11 ]. There has been a recent surge of interest in the investigation of pharmacological hypothermia as a treatment option for central nervous system (CNS) injuries.…”

Stroke Treatment: Current News and Developments

“…The effectiveness of hypothermia in stroke treatment will not be elucidated until the end of the Eurohyp-1 trial in which "external" cooling is being used (7). However, the use of hypothermia in neuro-intensive care units in patients with particularly large infarcts and/or brain edema appears to continue on the basis of the positive results of small studies (8).…”