title: Feasibility of endovascular and surface cooling strategies in acute stroke.
abstract: BACKGROUND
  Therapeutic hypothermia (TH) is a promising treatment of stroke, but limited data are available regarding the safety and effectiveness of cooling methodology. We investigated the safety of TH and compared the cooling capacity of two widely used cooling strategies - endovascular and surface cooling.
  
  
  METHODS
  COOLAID Oresund is a bicentre randomized trial in Copenhagen (Denmark) and Malmö (Sweden). Patients were randomized to either TH (33°C for 24 h) in a general intensive care unit (ICU) or standardized stroke unit care (control). Cooling was induced by a surface or endovascular-based strategy.
  
  
  RESULTS
  Thirty-one patients were randomized. Seven were cooled using endovascular and 10 using surface-based cooling methods and 14 patients received standard care (controls). 14 (45%) patients received thrombolysis. Pneumonia was recorded in 6 (35%) TH patients and in 1 (7%) control. 4 TH patients and 1 control developed massive infarction. 1 TH patient and 2 control suffered asymptomatic haemorrhagic transformation. Mortality was comparable with 2 (12%) in the TH group and 1 (7%) among controls. Mean (SD) duration of hospital stay was 25.0 days (24, 9) in TH and 22.5 days (20.6) in control patients (P = 0.767). Mean (SD) induction period (cooling onset to target temperature) was 126.3 min (80.6) with endovascular cooling and 196.3 min (76.3) with surface cooling (P = 0.025).
  
  
  CONCLUSIONS
  Therapeutic hypothermia with general anaesthesia is feasible in stroke patients. We noticed increased rates of pneumonia, while the length of hospital stay remained comparable. The endovascular cooling strategy provides a faster induction period than surface cooling.
authors.affiliation: Department of Neurology, Bispebjerg University Hospital Copenhagen, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Ovesen
authors.forename: M
authors.initials: M
authors.lastname: Brizzi
authors.forename: F C
authors.initials: FC
authors.lastname: Pott
authors.forename: H C
authors.initials: HC
authors.lastname: Thorsen-Meyer
authors.forename: T
authors.initials: T
authors.lastname: Karlsson
authors.forename: A
authors.initials: A
authors.lastname: Ersson
authors.forename: H
authors.initials: H
authors.lastname: Christensen
authors.forename: A
authors.initials: A
authors.lastname: Norrlin
authors.forename: P
authors.initials: P
authors.lastname: Meden
authors.forename: D W
authors.initials: DW
authors.lastname: Krieger
authors.forename: J
authors.initials: J
authors.lastname: Petersson
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D057510:Endovascular Procedures; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012537:Scandinavian and Nordic Countries; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome