title: No benefits of hypothermia in patients treated with hemicraniectomy for large ischemic stroke.
abstract: Background Space-occupying middle cerebral artery brain infarcts are associated with the development of brain edema, which may lead to cerebral herniation and death despite early hemicraniectomy. Aims To evaluate the benefit of therapeutic hypothermia in patients with space-occupying cerebral infarction treated with hemicraniectomy within 48 h of stroke onset. Methods Patients aged 18-60 years with space-occupying cerebral infarction treated with hemicraniectomy within 48 h and hypothermia (33-34°C) were selected from a single university hospital between 2001 and 2010 (n = 53). Patients treated with hemicraniectomy alone served as comparison group (n = 58), originating from three randomized controlled trials evaluating the effects of early decompressive surgery (DECIMAL, DESTINY, HAMLET). Primary outcome was the score on the modified Rankin scale at 12 months dichotomized between modified Rankin scale 0-3 and modified Rankin scale 4-6. Secondary outcome measures were modified Rankin scale score 0-4 and survival. Risk ratios were adjusted with Poisson regression. Results Mean patient age was 48 years. Median time from stroke onset to hemicraniectomy was 23.5 h in both treatment groups. Treatment with hypothermia had no effect on the primary outcome (modified Rankin scale 0-3 versus 4-6 (13/53 (25%) versus 24/58 (41%)); adjusted risk ratio 0.66, 95% confidence interval 0.38-1.13). Fewer patients treated with hypothermia had a modified Rankin scale score of 0-4 (21/53 (40%) versus 42/58 (72%); adjusted risk ratio 0.53, 95% confidence interval 0.37-0.76) and fewer patients survived (26/53 (49%) versus 46/58 (79%); adjusted risk ratio 0.60, 95% confidence interval 0.44-0.82). Conclusions In patients with space-occupying cerebral infarction, treatment with hypothermia had no additional benefit on functional outcome compared with treatment with hemicraniectomy alone.
authors.affiliation: 1 Department of Neurology and Dresden University Stroke Center, Dresden University of Technology, Dresden, Germany.
authors.forename: Hauke
authors.initials: H
authors.lastname: Schneider
authors.affiliation: 2 Department of Anesthesiology, Klinikum Dortmund gGmbH, Dortmund, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Krüger
authors.affiliation: 3 Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.|4 Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.affiliation: 5 Department of Neurology, Rijnstate Hospital, Arnhem, Netherlands.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Hofmeijer
authors.affiliation: 3 Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: H Bart
authors.initials: HB
authors.lastname: van der Worp
authors.affiliation: 6 Department of Neurology, Ostalb-Klinikum Aalen, Aalen, Germany.|7 Department of Neurology, University of Ulm, Ulm, Germany.
authors.forename: Eric
authors.initials: E
authors.lastname: Jüttler
authors.affiliation: 8 Neurology Centre, Générale de Sante, Hôpital Privé d'Antony, Antony, and AP-HP, Hôpital Lariboisière, Paris, France.
authors.forename: Katayoun
authors.initials: K
authors.lastname: Vahedi
authors.affiliation: 9 Department of Neurosurgery, Dresden University of Technology, Dresden, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schackert
authors.affiliation: 1 Department of Neurology and Dresden University Stroke Center, Dresden University of Technology, Dresden, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Reichmann
authors.affiliation: 1 Department of Neurology and Dresden University Stroke Center, Dresden University of Technology, Dresden, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Puetz
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000453:epidemiology / Q000628:therapy*; D002544:Cerebral Infarction / Q000453:epidemiology / Q000628:therapy*; D003399:Craniotomy; D003422:Critical Care; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hypothermia; critical care; hemicraniectomy; space-occupying ischemic stroke