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Mild Hypothermia Therapy Curbs Post-Stroke Risks
A DGReview of :"Feasibility and Safety of Inducing Modest Hypothermia in Awake Patients With Acute Stroke Through Surface Cooling: A Case-Control Study : The Copenhagen Stroke Study"
Stroke
09/11/2000
By Anne MacLennan
Lowering the body temperature slightly within a few hours of stroke can reduce brain damage and risk of death, a study suggests.
Fully conscious patients in whom modest hypothermia was achieved via surface cooling had a six-month survival rate nearly twice that of untreated control patients.
The finding argues strongly for a large, randomized clinical trial to test the therapy in unselected patients with stroke, study authors note. If future trials support this result, most stroke patients may be able to benefit from this treatment in the near future, they add.
Until now, investigation of hypothermia treatment in humans has been limited and carried out only in patients under full anaesthesia.
Participants in this prospective study were 17 patients with stroke admitted within 12 hours from stroke onset. They were given hypothermic treatment for six hours by forced air, a surface cooling method using a cooling blanket with a flow of cool air (10 degrees Celsius). For the associated compensatory shivering, they received pethidine injections.
On average, body temperatures were reduced by 1.3 degrees Celsius to 35.5 degrees from 36.8, and hypothermia was present until four hours after therapy.
Controls were 56 patients from the Copenhagen Stroke Study matched for age, gender, initial stroke severity, body temperature on admission and time from stroke onset to admission. Blood cytology, biochemistry, electrocardiograms (ECGs) and body temperature were monitored during treatment and outcome analyses were performed to test treatment safety.
Mortality at six months after stroke was 12 per cent in cases versus 23 per cent in controls. Final neurological impairment (Scandinavian Stroke Scale at six months) was mean 42.4 points in cases versus 47.9 in controls. The therapy was not a predictor of poor outcome in any analyses.
"Feasibility and Safety of Inducing Modest Hypothermia in Awake Patients With Acute Stroke Through Surface Cooling: A Case-Control Study : The Copenhagen Stroke Study"
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