Therapeutic hypothermia complicated by spontaneous brain stem hemorrhage

Cho, Hang Joo; Kyong, Yeon Young; Oh, Yonghwan; Choi, Se Joon; Choi, Kyoung Ho; Oh, Joo Suk

doi:10.1016/j.ajem.2012.04.017

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…Hypothermia to 32C led to reduced fibrinogen and impaired thrombin generation (Martini, 2007). While therapeutic cooling in mild to moderate ranges was not thought to increase brain hemorrhage risk (Resnick et al, 1994), spontaneous brain hemorrhage has complicated this intervention in a case of cardiac arrest (Cho et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Mild Hypothermia Reduces Tissue Plasminogen Activator-Related Hemorrhage and Blood Brain Barrier Disruption After Experimental Stroke

Tang

Liu

Koike

et al. 2013

Therapeutic Hypothermia and Temperature Management

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Therapeutic hypothermia has shown neuroprotective promise, but whether it can be used to improve outcome in stroke has yet to be determined in patients. Recombinant tissue plasminogen activator (rt-PA) is only given to a minority of patients with acute ischemic stroke, and is not without risk, namely significant brain hemorrhage. We explored whether mild hypothermia, in combination with rt-PA, influences the safety of rt-PA. Mice were subjected to middle cerebral artery occlusion (MCAO) using a filament model, followed by 24 hours reperfusion. Two paradigms were studied. In the first paradigm, cooling and rt-PA treatment began at the same time upon reperfusion, whereas in the second paradigm, cooling began soon after ischemia onset, and rt-PA began after rewarming and upon reperfusion. Experimental groups included: tPA treatment at normothermia (37°C), rt-PA treatment at hypothermia (33°C), no rt-PA at normothermia, and no rt-PA treatment at hypothermia. Infarct size, neurological deficit scores, blood brain barrier (BBB) permeability, brain hemorrhage, and expression of endogenous tissue plasminogen activator (tPA) and its inhibitor, plasminogen activator inhibitor (PAI-1) were assessed. For both paradigms, hypothermia reduced infarct size and neurological deficits compared to normothermia, regardless of whether rt-PA was given. rt-PA treatment increased brain hemorrhage and BBB disruption compared to normothermia, and this was prevented by cooling. However, mortality was higher when rt-PA and cooling were administered at the same time, beginning 1-2 hours post MCAO. Endogenous tPA expression was reduced in hypothermic mice, whereas PAI-1 levels were unchanged by cooling. In the setting of rt-PA treatment, hypothermia reduces brain hemorrhage, and BBB disruption, suggesting that combination therapy with mild hypothermia and rt-PA appears safe.

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Section: Discussionmentioning

confidence: 99%

Mild Hypothermia Reduces Tissue Plasminogen Activator-Related Hemorrhage and Blood Brain Barrier Disruption After Experimental Stroke

Tang

Liu

Koike

et al. 2013

Therapeutic Hypothermia and Temperature Management

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“…However, most of them were related to the arterial catheterization access for percutaneous coronary intervention [27]. It is known that hypothermia causes coagulopathy with increased clotting time; this event is called hypothermic coagulopathy [34]. One Meta-Analysis of Randomized Controlled Trials [35], which consisted of 43 trials and included 7,528 patients, did not find an increased risk of hemorrhage in patients treated with TTM in general, despite a higher risk of thrombocytopenia and transfusion requirement for patients treated with TTM, particularly in those cooled longer than 48 hours.…”

Section: Discussionmentioning

confidence: 99%

Should targeted temperature management be used in cardiogenic shock patients? Systematic review and meta-analysis

Nieborek¹,

Ładny

Jaguszewski

et al. 2022

Cardiol J.

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“…[6] The risk of bleeding is highly associated with hypothermia management, especially if thrombolysis or cardiac intervention has to be done. [78] Bedside echocardiogram is a useful diagnostic tool to determine heart valve and pericardium integrity, ventricular function and to differentiate kinds of shock. [9] Coronary catheterization and emergency percutaneous coronary intervention remains the principal approach for the resuscitated patients presenting with ST-segment elevation and high troponins.…”

Section: Discussionmentioning

confidence: 99%

Benefits of thrombolytics in prolonged cardiac arrest and hypothermia over its bleeding risk

Gupta

Jindal

Cranston-D'Amato

2014

Int J Crit Illn Inj Sci

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A 52-year-old non-smoking Caucasian male, who was admitted to our emergency room after he was found unconscious in the bathroom, went into cardiac arrest requiring prolonged cardiopulmonary resuscitation (CPR) and hypothermia therapy. Cardiac catheterization showed non-obstructive coronary arteries and further bedside echocardiogram suggested probable pulmonary embolism (PE) as an underlying cause of cardiac arrest. Although thrombolytic therapy is an effective therapy for PE, it is not routinely given during prolonged CPR for its life- threatening bleeding complications. Many reported cases have suggested a beneficial effect of empiric thrombolytic in cardiac arrest, but unrelated to duration of resuscitation and adjuvant treatments that imposes bleeding risk. We suspect that tissue plasminogen activator (tPA) should be promptly given to prolonged cardiac arrest patients, even when bleeding risk is high with the concurrent hypothermia treatment, keeping the benefits over risk strategy. Our patient received thrombolytic, tPA and showed remarkable clinical, physiological and radiographical improvement.

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Therapeutic hypothermia complicated by spontaneous brain stem hemorrhage

Cited by 6 publications

References 8 publications

Mild Hypothermia Reduces Tissue Plasminogen Activator-Related Hemorrhage and Blood Brain Barrier Disruption After Experimental Stroke

Mild Hypothermia Reduces Tissue Plasminogen Activator-Related Hemorrhage and Blood Brain Barrier Disruption After Experimental Stroke

Should targeted temperature management be used in cardiogenic shock patients? Systematic review and meta-analysis

Benefits of thrombolytics in prolonged cardiac arrest and hypothermia over its bleeding risk

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