Intravascular cooling for rapid induction of moderate hypothermia in severely head-injured patients: results of a multicenter study (IntraCool).
OBJECTIVE
To evaluate the feasibility, safety and effectiveness of a new method of intravascular temperature management for inducing moderate hypothermia (MHT).


METHODS
Prospective, international-multicenter clinical trial conducted in four university hospitals.


METHODS
In a 2-year period 24 patients with severe head injury and refractory high ICP were treated with MHT (32.5 degrees C) by intravascular methods.


RESULTS
Seventeen were males and seven females, with a median age of 25 years (range 15-60). The median Glasgow Coma Scale upon admission was 7 (range 3-13) and the median Injury Severity Score was 22 (range 13-43). A total of 75% of patients presented a diffuse lesion in the pre-enrollment computed tomography. Median time from injury until reaching refractory high ICP was 71.5 h after injury (minimum 14 h, maximum 251 h). Twelve patients (50%) reached this situation within the first 72 h after injury. MHT was attained in a median time of 3 h. Pre-enrollment median ICP was 23.8 mmHg and was reduced to 16.8 mmHg upon reaching target temperature. At 6 months after injury, nine patients had died (37.5%), six were severely disabled (25%), two moderately disabled (8.3%) and seven had a good recovery (29.2%). Of the nine patients who died, in four the cause was rebound ICP during rewarming, one death was attributed to accidental potassium overload, two to septic shock, one to cardiac arrest of unknown origin and the ninth to a pulmonary embolism.


CONCLUSIONS
Intravascular methods to induce MHT combined with precooling with cold saline at 4 degrees C appear to be feasible and effective in reducing ICP in patients with high ICP refractory to first-line therapeutic measures.
Sahuquillo
Juan
J
Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. sahuquillo@neurotrauma.net
Pérez-Bárcena
Jon
J
Biestro
Alberto
A
Zavala
Elizabeth
E
Merino
Mari-Angels
MA
Vilalta
Anna
A
Poca
Maria Antonia
MA
Garnacho
Angel
A
Adalia
Ramon
R
Homar
Javier
J
LLompart-Pou
Juan Antonio
JA
D000293:Adolescent; D000328:Adult; D001831:Body Temperature; D001930:Brain Injuries / Q000453:epidemiology*; D005240:Feasibility Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007262:Infusions, Intravenous; D015601:Injury Severity Score; D019586:Intracranial Hypertension / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
D009638:Norepinephrine