Comparison of endovascular and surface cooling during unruptured cerebral aneurysm repair.
OBJECTIVE
To compare endovascular versus surface methods for the induction and reversal of hypothermia during neurosurgery in a multicenter, prospective, randomized study.


METHODS
Patients undergoing elective open craniotomy for repair of an unruptured cerebral aneurysm (n = 153) were randomly assigned (2:1) to undergo whole-body hypothermia to 33 degrees C, either with an endovascular cooling device placed in the inferior vena cava via the femoral vein (n = 92) or with a surface convective air blanket (n = 61). Active rewarming was accomplished using the same devices.


RESULTS
Cooling rates in endovascular and surface blanket groups averaged 4.77 and 0.87 degrees C/h, respectively (P < 0.001). When the first temporary arterial or aneurysm clip was placed, 99% of endovascular patients and 20% of surface blanket patients had reached the target of 33 degrees C (P < 0.001). Obese patients were cooled efficiently with the endovascular approach (3.56 degrees C/h). Rewarming rates averaged 1.88 degrees C/h for endovascular patients and 0.69 degrees C/h for surface blanket patients (P < 0.001). By the end of surgery, 89 and 53% of these patients, respectively, had rewarmed to at least 35 degrees C (P < 0.001). On leaving the operating room, 14% of endovascular patients and 28% of surface blanket patients were still intubated (P = 0.035). The overall safety of the two procedures was comparable. No clinically significant catheter-related thrombotic, bleeding, or infectious complications were reported in the endovascular group.


CONCLUSIONS
Endovascular cooling provided superior induction, maintenance, and reversal of hypothermia compared with the surface blanket, without an increase in complications. Endovascular cooling may have clinical benefit for patients undergoing cerebrovascular surgery, as well as patients with acute stroke, head injury, or acute myocardial infarction.
Stanford University Medical Center, Stanford, California 94305, USA. gsteinberg@stanford.edu
Gary K
GK
Steinberg
Christopher S
CS
Ogilvy
Lawrence M
LM
Shuer
E Sander
ES
Connolly
Robert A
RA
Solomon
Arthur
A
Lam
Neal F
NF
Kassell
Christopher J
CJ
Baker
Steven L
SL
Giannotta
Kevin M
KM
Cockroft
Teresa E
TE
Bell-Stephens
Robin L
RL
Allgren
D000293:Adolescent; D000328:Adult; D000368:Aged; D001833:Body Temperature Regulation / Q000502:physiology; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002533:Cerebral Angiography; D003399:Craniotomy; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation*; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013673:Technology Assessment, Biomedical; D014682:Vena Cava, Inferior