Therapeutic hypothermia in patients with aneurysmal subarachnoid hemorrhage, refractory intracranial hypertension, or cerebral vasospasm.
OBJECTIVE
To evaluate the feasibility and safety of mild hypothermia treatment in patients with aneurysmal subarachnoid hemorrhage (SAH) who are experiencing intracranial hypertension and/or cerebral vasospasm (CVS).


METHODS
Of 441 consecutive patients with SAH, 100 developed elevated intracranial pressure and/or symptomatic CVS refractory to conventional treatment. Hypothermia (33-34 degrees C) was induced and maintained until intracranial pressure normalized, CVS resolved, or severe side effects occurred.


RESULTS
Thirteen patients were treated with hypothermia alone, and 87 were treated with hypothermia in combination with barbiturate coma. Sixty-six patients experienced poor-grade SAH (Hunt and Hess Grades IV and V) and 92 had Fisher Grade 3 and 4 bleedings. The mean duration of hypothermia was 169 +/- 104 hours, with a maximum of 16.4 days. The outcome after 1 year was evaluated in 90 of 100 patients. Thirty-two patients (35.6%) survived with good functional outcome (Glasgow Outcome Scale [GOS] score, 4 and 5), 14 (15.5%) were severely disabled (GOS score, 3), 1 (1.1%) was in a vegetative state (GOS score, 2), and 43 (47.8%) died (GOS score, 1). The most frequent side effects were electrolyte disorders (77%), pneumonia (52%), thrombocytopenia (47%), and septic shock syndrome (40%). Of 93 patients with severe side effects, 6 (6.5%) died as a result of respiratory or multi-organ failure.


CONCLUSIONS
Prolonged systemic hypothermia may be considered as a last-resort option for a carefully selected group of SAH patients with intracranial hypertension or CVS resistant to conventional treatment. However, complications associated with hypothermia require elaborate protocols in general intensive care unit management.
Seule
Martin A
MA
Neurointensive Care Unit, Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland. martin.seule@kssg.ch
Muroi
Carl
C
Mink
Susanne
S
Yonekawa
Yasuhiro
Y
Keller
Emanuela
E
D000367:Age Factors; D001463:Barbiturates; D003128:Coma; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D019586:Intracranial Hypertension / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000628:therapy
D001463:Barbiturates