Mild controlled hypothermia – a neuroprotective method for late ischaemic complications in resuscitation care for patients with severe spontaneous subarachnoid hemorrhage caused by aneurism rupture


Authors: E. Neuman 1;  M. Smrčka 1;  R. Gál 2;  R. Jura 3
Authors‘ workplace: Neurochirurgická klinika LF MU a FN Brno 1;  Klinika anestezie, resuscitace a intenzivní medicíny LF MU a FN Brno 2;  Neurologická klinika LF MU a FN Brno 3
Published in: Cesk Slov Neurol N 2008; 71/104(2): 180-187
Category: Original Paper

Overview

Introduction:
The article deals with the potential for the use and the benefit of mild controlled hypothermia in resuscitation care for patients with spontaneous subarachnoid hemorrhage (SAH) of grade IV and V according to Hunt and Hess scale (H-H), with the objective to increase the tolerance of ischemia developing in the cerebral tissue as a result of vasospasms (delayed cerebral ischemia, DCI).

Patient set:
3 groups of patients with SAH H-H IV and V. Group 1 included patients treated in 2003, a total of 12 patients aged 56 on average, with mean Fisher score 3.25. Group 2 included patients treated from the beginning of 2004 to mid 2005, a total of 13 patients aged 51 years on average, with mean Fisher score 3.23. Group 3 of patients (with retrospectively acquired data) were those treated in 2002, a total of 12 patients aged 50 years on average, with mean Fisher score 3.50. Only the patients with proven aneurysm treated with coiling were enrolled in the study.

Methodology:
Mild controlled hypothermia at 34° C was applied, induced by means of surface cooling for the period of 72 hours (a Hypo 01 apparatus made by the Czech Space Research Centre, s.r.o). In the first group of patients, hypothermia was induced immediately after admission. In the second group of patients, hypothermia was applied after the evidence of vasospasms (by means of transcranial Doppler imaging (TCD), or detected by CT in case of ischaemia). The third group of patients (with retrospectively acquired data) was the control group. 

Results:
The use of hypothermia applied immediately after admission (the first above-mentioned group) did not improve the results of treatment (evaluated using the Glasgow Outcome Score, GOS). The use of hypothermia only upon detection of vasospasms (the second group of patients) did improve the results of treatment, but the improvement did not achieve the level of statistical significance (p=0.11).

Conclusions:
Mild controlled hypothermia at 34˚ C lasting for 72 hours applied to patients with detected vasospasms was observed to improve the results of treatment of patients with SAH H-H IV and I at risk of ischaemia. However, improvement of treatment results did not achieve the level of statistical significance.

Key words:
spontaneous subarachnoid hemorrhage – vasospasm – cerebral ischaemia  - mild controlled hypothermia


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Paediatric neurology Neurosurgery Neurology
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