Ice-cold saline for the induction of mild hypothermia in patients with acute ischemic stroke: a pilot study.
OBJECTIVE
Neuroprotective effects of induced hypothermia depend on its time point of initiation after acute brain injury. Preliminary studies in cardiac arrest patients indicate that rapid infusion of ice cold saline (ICS) is safe and effective for induction of hypothermia. We investigated its use in patients with acute ischemic stroke (AIS).


METHODS
Patients (n=10) with AIS were included within 3 hours after symptom onset. After cranial CT, they were treated-if indicated-with rt-PA. ICS of 4 degrees C (25 mL/kg body weight) was administered via peripheral intravenous lines. Patients received buspirone/pethidine to prevent and treat shivering. After infusion of the target volume of ICS, no further efforts were made to maintain hypothermia by other methods.


RESULTS
Ten patients with a median National Institutes of Health Stroke Scale (NIHSS) score of 5.5 (range 4 to 12) on admission were included into the study. Nine patients were treated with thrombolysis within a time window of 104+/-25 minutes. A mean amount of 2163+/-256 mL ICS was infused 17+/-11 minutes after rt-PA infusion had started. Tympanic temperature dropped significantly by a maximum of 1.6+/-0.3 degrees C (P<0.005) at 52+/-16 minutes after ICS was started. The procedure was well tolerated. The NIHSS score improved significantly to a median of 1 (range 1 to 15) at discharge compared to admission (P<0.02).


CONCLUSIONS
This pilot study suggests that rapid ICS infusions in combination with pethidine and buspirone lower the body temperature significantly without major side effects.
Kollmar
Rainer
R
Department of Neurology, University of Erlangen-Nuernberg, Erlangen, Germany. rainer.kollmar@uk-erlangen.de
Schellinger
Peter D
PD
Steigleder
Tobias
T
Köhrmann
Martin
M
Schwab
Stefan
S
D000208:Acute Disease; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001772:Blood Cell Count; D001774:Blood Chemical Analysis; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy*; D002065:Buspirone / Q000627:therapeutic use; D003080:Cold Temperature; D003627:Data Interpretation, Statistical; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D008875:Middle Aged; D010865:Pilot Projects; D012702:Serotonin Antagonists / Q000627:therapeutic use; D012768:Shivering / Q000187:drug effects / Q000502:physiology; D012965:Sodium Chloride; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed
D000701:Analgesics, Opioid; D012702:Serotonin Antagonists; D012965:Sodium Chloride; D008614:Meperidine; D002065:Buspirone