title: Cooling in intracerebral hemorrhage (CINCH) trial: protocol of a randomized German-Austrian clinical trial.
abstract: BACKGROUND
  Intracerebral hemorrhage accounts for up to 15% of all strokes and is frequently associated with poor functional outcome and high mortality. So far, there is no clear evidence for a specific therapy, apart from general stroke unit or neurointensive care and management of secondary complications. Promising experimental and pilot clinical data support the use of therapeutic hypothermia after intracerebral hemorrhage.
  
  
  OBJECTIVE
  The study aims to determine if therapeutic hypothermia improves survival rates and reduces cerebral lesion volume after large intracerebral hemorrhage compared with conventional treatment.
  
  
  METHODS
  The Cooling in IntraCerebral Hemorrhage trial is a prospective, multicenter, interventional, randomized, parallel, two-arm (1 : 1) phase II trial with blinded end-point adjudication. Enrolment: 50 patients (age: 18 to 65 years) with large (25 to 64 ml on cranial computertomography), primary intracerebral hemorrhage of the basal ganglia or thalamus within 6 to 18 h after symptom onset are randomly allocated to therapeutic hypothermia for eight-days or conventional temperature management. In the therapeutic hypothermia group, a target temperature of 35.0°C is achieved by endovascular catheters and followed by slow controlled rewarming. Data analysis is based on the intent-to-treat population. The primary outcome measure of the study is the development in total lesion volume on cranial computertomography (intracerebral hemorrhage plus perihemorrhagic edema on day 8 ± 0.5 and day 1 ± 0.5 after intracerebral hemorrhage) and the mortality after 30 days. Secondary end-points are the in-hospital mortality, mortality, and functional outcome (modified Rankin Scale and Barthel-Index) after 90 and 180 days. Safety measures include any adverse events associated with therapeutic hypothermia.
  
  
  CONCLUSIONS
  In the face of a lack of evidence-based therapies for patients with large intracerebral hemorrhage, new promising approaches are desperately needed, but need evaluation in randomized controlled trials.
  
  
  CONCLUSIONS
  The results of Cooling in IntraCerebral Hemorrhage trial are believed to directly influence future therapy of large intracerebral hemorrhage.
authors.affiliation: Department of Neurology, University Hospital Erlangen; Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. rainer.kollmar@uk-erlangen.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Kollmar
authors.forename: Eric
authors.initials: E
authors.lastname: Juettler
authors.forename: Hagen B
authors.initials: HB
authors.lastname: Huttner
authors.forename: Arnd
authors.initials: A
authors.lastname: Dörfler
authors.forename: Dimitre
authors.initials: D
authors.lastname: Staykov
authors.forename: Bernd
authors.initials: B
authors.lastname: Kallmuenzer
authors.forename: Erich
authors.initials: E
authors.lastname: Schmutzhard
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.forename: Gregor
authors.initials: G
authors.lastname: Broessner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D002543:Cerebral Hemorrhage / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017694:Rewarming; D013534:Survival; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult