J Korean Med Sci.  2017 Aug;32(8):1337-1344. 10.3346/jkms.2017.32.8.1337.

Feasibility and Safety of Mild Therapeutic Hypothermia in Poor-Grade Subarachnoid Hemorrhage: Prospective Pilot Study

• Choi W
• Kwon SC
• Lee WJ
• Weon YC
• Choi B
• Lee H
• Park ES
• Ahn R

• KMID: 2439469
• DOI: http://doi.org/10.3346/jkms.2017.32.8.1337

Abstract

Therapeutic hypothermia (TH) improves the neurological outcome in patients after cardiac arrest and neonatal hypoxic brain injury. We studied the safety and feasibility of mild TH in patients with poor-grade subarachnoid hemorrhage (SAH) after successful treatment. Patients were allocated randomly to either the TH group (34.5°C) or control group after successful clipping or coil embolization. Eleven patients received TH for 48 hours followed by 48 hours of slow rewarming. Vasospasm, delayed cerebral ischemia (DCI), functional outcome, mortality, and safety profiles were compared between groups. We enrolled 22 patients with poor-grade SAH (Hunt & Hess Scale 4, 5 and modified Fisher Scale 3, 4). In the TH group, 10 of 11 (90.9%) patients had a core body temperature of < 36°C for > 95% of the 48-hour treatment period. Fewer patients in the TH than control group (n = 11, each) had symptomatic vasospasms (18.1% vs. 36.4%, respectively) and DCI (36.3% vs. 45.6%, respectively), but these differences were not statistically significant. At 3 months, 54.5% of the TH group had a good-to-moderate functional outcome (0-3 on the modified Rankin Scale [mRS]) compared with 9.0% in the control group (P = 0.089). Mortality at 1 month was 36.3% in the control group compared with 0.0% in the TH group (P = 0.090). Mild TH is feasible and can be safely used in patients with poor-grade SAH. Additionally, it may reduce the risk of vasospasm and DCI, improving the functional outcomes and reducing mortality. A larger randomized controlled trial is warranted.

Keyword

Therapeutic Hypothermia; Target Temperature Management; Subarachnoid Hemorrhage; Cerebral Vasospasm; Delayed Cerebral Ischemia; Aneurysm; Rewarming

MeSH Terms

Aneurysm
Body Temperature
Brain Injuries
Brain Ischemia
Embolization, Therapeutic
Heart Arrest
Humans
Hypothermia, Induced*
Mortality
Pilot Projects*
Prospective Studies*
Rewarming
Subarachnoid Hemorrhage*
Vasospasm, Intracranial

Figure

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  Fig. 1 Comparison of core body temperature changes in TH and control.

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  Fig. 2 Distribution of 3-month mRS scores of hypothermia (n = 11) and control patients (n = 11). mRS = modified Rankin Scale. *P = 0.063.

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