Feasibility of endovascular and surface cooling strategies in acute stroke

• Background Therapeutic hypothermia (TH) is a promising treatment of stroke, but limited data are available regarding the safety and effectiveness of cooling methodology. We investigated the safety of TH and compared the cooling capacity of two widely used cooling strategies endovascular and surface cooling. Methods COOLAID Oresund is a bicentre randomized trial in Copenhagen (Denmark) and Malmo (Sweden). Patients were randomized to either TH (33 degrees C for 24h) in a general intensive care unit (ICU) or standardized stroke unit care (control). Cooling was induced by a surface or endovascular-based strategy. Results Thirty-one patients were randomized. Seven were cooled using endovascular and 10 using surface-based cooling methods and 14 patients received standard care (controls). 14 (45%) patients received thrombolysis. Pneumonia was recorded in 6 (35%) TH patients and in 1 (7%) control. 4 TH patients and 1 control developed massive infarction. 1 TH patient and 2 control suffered asymptomatic haemorrhagic transformation. Mortality was comparable with 2 (12%) in the TH group and 1 (7%) among controls. Mean (SD) duration of hospital stay was 25.0days (24, 9) in TH and 22.5days (20.6) in control patients (P=0.767). Mean (SD) induction period (cooling onset to target temperature) was 126.3min (80.6) with endovascular cooling and 196.3min (76.3) with surface cooling (P=0.025). Conclusions Therapeutic hypothermia with general anaesthesia is feasible in stroke patients. We noticed increased rates of pneumonia, while the length of hospital stay remained comparable. The endovascular cooling strategy provides a faster induction period than surface cooling.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

Keyword

stroke

hypothermia

cerebral infarction

ischaemic stroke

acute stroke

therapy

Publication and Content Type

art (subject category)

ref (subject category)