Acute Crit Care.  2024 May;39(2):282-293. 10.4266/acc.2024.00612.

The efficacy of therapeutic hypothermia in patients with poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

• Lee S
• Kim M
• Kwon MY
• Kwon SM
• Ko YS
• Chung Y
• Park W
• Park JC
• Ahn JS
• Jeon H
• Im J
• Kim JH

• KMID: 2557245
• DOI: http://doi.org/10.4266/acc.2024.00612

Abstract

Background
This study evaluates the effectiveness of Therapeutic Hypothermia (TH) in treating poor-grade aneurysmal subarachnoid hemorrhage (SAH), focusing on functional outcomes, mortality, and complications such as vasospasm, delayed cerebral ischemia (DCI), and hydrocephalus. Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive literature search was conducted across multiple databases, including Medline, Embase, and Cochrane Central, up to November 2023. Nine studies involving 368 patients were selected based on eligibility criteria focusing on TH in poor-grade SAH patients. Data extraction, bias assessment, and evidence certainty were systematically performed. Results: The primary analysis of unfavorable outcomes in 271 participants showed no significant difference between the TH and standard care groups (risk ratio [RR], 0.87). However, a significant reduction in vasospasm was observed in the TH group (RR, 0.63) among 174 participants. No significant differences were found in DCI, hydrocephalus, and mortality rates in the respective participant groups. Conclusions: TH did not significantly improve primary unfavorable outcomes in poor-grade SAH patients. However, the reduction in vasospasm rates indicates potential specific benefits. The absence of significant findings in other secondary outcomes and mortality highlights the need for further research to better understand TH's role in treating this patient population.

Keyword

hypothermia; intracranial vasospasm; mortality; stroke; subarachnoid hemorrhage

Figure

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  Figure 1. The flow diagram of the literature search. SAH: subarachnoid hemorrhage.

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  Figure 2. Forest plot of studies comparing unfavorable functional outcomes in the therapeutic hypothermia group with that in the control group. The horizontal bars represent 95% confidence intervals (CIs).

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  Figure 3. Forest plot of studies comparing the subarachnoid hemorrhage related complication and mortality in the therapeutic hypothermia group with that in the control group. (A) Fours studies reported vasospasm. The meta-analysis of risk ratio reported a statistically lower incidence of vasospasm in patients treated with therapeutic hypothermia. (B) Three studies reported delayed cerebral ischemia. There was no significant effect involving therapeutic hypothermia and delayed cerebral ischemia. (C) Three studies reported hydrocephalus. There was no significant effect involving therapeutic hypothermia and hydrocephalus. (D) Fives studies reported mortality. There was no significant effect involving therapeutic hypothermia and mortality. CI: confidence interval.

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