Clinical application of modest hypothermia after spinal cord injury.
There is widespread interest in the use of hypothermia in the treatment of CNS injury. While there is considerable experience in the use of cooling for a variety of brain pathologies, limited data exist after spinal cord injury. In the past few years, technological advances in the induction and maintenance of cooling have been achieved and can potentially allow for a more accurate evaluation of this form of treatment. We report a series of 14 patients with an average age of 39.4 years (range, 16-62 years) with acute, complete (AIS A) cervical spinal cord injuries who underwent a protocol using an intravascular cooling catheter to achieve modest (33 degrees C) systemic hypothermia. There was an excellent correlation between intravascular and intrathecal cerebrospinal fluid temperature. The average time between injury and induction of hypothermia was 9.17 +/- 2.24 h (mean +/- SEM); the time to target temperature was 2.72 +/- 0.42 h; the duration of cooling at target temperature was 47.6 +/- 3.1 h; the average total length of time of cooling was 93.6 +/- 4 h. There was a positive correlation between temperature and heart rate. Most documented adverse events were respiratory in nature. We were able to effectively deliver systemic cooling using the cooling catheters with minimal variation in body temperature. The study represents the largest, modern series of hypothermia treatment of acute spinal cord injury with intravascular cooling techniques and provides needed baseline data for outcome studies to include larger multi-center, randomized trials.
Levi
Allan D
AD
Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida 33136, USA. alevi@med.miami.edu
Green
Barth A
BA
Wang
Michael Y
MY
Dietrich
W Dalton
WD
Brindle
Ted
T
Vanni
Steven
S
Casella
Gizelda
G
Elhammady
Gina
G
Jagid
Jonathan
J
D000293:Adolescent; D000328:Adult; D001831:Body Temperature / Q000502:physiology*; D002404:Catheterization; D002555:Cerebrospinal Fluid / Q000502:physiology; D002574:Cervical Vertebrae / Q000293:injuries; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D013116:Spinal Cord / Q000378:metabolism / Q000503:physiopathology*; D013119:Spinal Cord Injuries / Q000134:cerebrospinal fluid / Q000503:physiopathology* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult