Clinical outcomes using modest intravascular hypothermia after acute cervical spinal cord injury.
BACKGROUND
Although a number of neuroprotective strategies have been tested after spinal cord injury (SCI), no treatments have been established as a standard of care.


OBJECTIVE
We report the clinical outcomes at 1-year median follow-up, using endovascular hypothermia after SCI and a detailed analysis of the complications.


METHODS
We performed a retrospective analysis of American Spinal Injury Association and International Medical Society of Paraplegia Impairment Scale (AIS) scores and complications in 14 patients with SCI presenting with a complete cervical SCI (AIS A). All patients were treated with 48 hours of modest (33 degrees C) intravascular hypothermia. The comparison group was composed of 14 age- and injury-matched subjects treated at the same institution.


RESULTS
Six of the 14 cooled patients (42.8%) were incomplete at final follow-up (50.2 [9.7] weeks). Three patients improved to AIS B, 2 patients improved to AIS C, and 1 patient improved to AIS D. Complications were predominantly respiratory and infectious in nature. However, in the control group, a similar number of complications was observed. Adverse events such as coagulopathy, deep venous thrombosis, and pulmonary embolism were not seen in the patients undergoing hypothermia.


CONCLUSIONS
This study is the first phase 1 clinical trial on the safety and outcome with the use of endovascular hypothermia in the treatment of acute cervical SCI. In this small cohort of patients with SCI, complication rates were similar to those of normothermic patients with an associated AIS A conversion rate of 42.8%.
Levi
Allan D
AD
Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida, USA. alevi@med.miami.edu
Casella
Gizelda
G
Green
Barth A
BA
Dietrich
W Dalton
WD
Vanni
Steven
S
Jagid
Jonathan
J
Wang
Michael Y
MY
D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000209:etiology* / Q000473:pathology; D007036:Hypothermia, Induced / Q000379:methods*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult