title: Induction of cooling with a passive head and neck cooling device: effects on brain temperature after stroke.
abstract: OBJECTIVE
  Therapeutic hypothermia improves clinical outcome after cardiac arrest and appears beneficial in other cerebrovascular diseases. We conducted this study to investigate the relationship between surface head/neck cooling and brain temperature.
  
  
  METHODS
  Prospective observational study enrolling consecutive patients with severe ischemic or hemorrhagic stroke undergoing intracranial pressure (ICP) and brain temperature monitoring. Arterial pressure, ICP, cerebral perfusion pressure, heart rate, brain, tympanic, and bladder temperature were continuously registered. Fifty-one applications of the Sovika cooling device were analyzed in 11 individual patients.
  
  
  RESULTS
  Sovika application led to a significant decrease of brain temperature compared with baseline with a maximum of -0.36°C (SD, 0.22) after 49 minutes (SD, 17). During cooling, dynamics of brain temperature differed significantly from bladder (-0.25°C [SD, 0.15] after 48 minutes [SD, 19]) and tympanic temperature (-1.79°C [SD, 1.19] after 37 minutes [SD, 16]). Treatment led to an increase in systolic arterial pressure by >20 mm Hg in 14 applications (n=7 patients) resulting in severe hypertension (>180 mm Hg) in 4 applications (n=3). ICP increased by >10 mm Hg in 7 applications (n=3), led to ICP crisis >20 mm Hg in 6 applications (n=3), and a drop of cerebral perfusion pressure <50 mm Hg in 1 application.
  
  
  CONCLUSIONS
  Although the decrease of brain temperature after Sovika cooling device application was statistically significant, we doubt clinical relevance of this rather limited effect (-0.36°C). Moreover, the transient increases of blood pressure and ICP warrant caution.
authors: Department of Neurology, University of Heidelberg, Heidelberg, Germany.
authors: Sven
authors: S
authors: Poli
authors: Jan
authors: J
authors: Purrucker
authors: Miriam
authors: M
authors: Priglinger
authors: Jennifer
authors: J
authors: Diedler
authors: Marek
authors: M
authors: Sykora
authors: Erik
authors: E
authors: Popp
authors: Thorsten
authors: T
authors: Steiner
authors: Roland
authors: R
authors: Veltkamp
authors: Julian
authors: J
authors: Bösel
authors: André
authors: A
authors: Rupp
authors: Werner
authors: W
authors: Hacke
authors: Christian
authors: C
authors: Hametner
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000502:physiology*; D004864:Equipment and Supplies / Q000009:adverse effects; D005260:Female; D006257:Head; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009333:Neck; D011446:Prospective Studies; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*; D013696:Temperature; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000502:physiology; D001743:Urinary Bladder / Q000502:physiology