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Cooling Effective In Acute Ischemic Brain Damage
Stroke
08/03/2001
By Anne MacLennan
Induced hypothermia appears to be feasible and safe in patients with acute ischemic stroke, even after thrombolysis.
At the same time, however, further study is required around refinements in the cooling process, optimal target temperature, duration of therapy, and clinical efficacy.
Although hypothermia has been found to be effective in improving outcome in experimental models of brain infarction, these authors examined its feasibility and safety in patients with acute ischemic stroke treated with thrombolysis.
Dr Derk W. Krieger and colleagues from the Cerebrovascular Center, The Cleveland Clinic Foundation, Cleveland, Ohio, United States did this open pilot study.
All patients presented with major ischemic stroke within six hours of onset.
After informed consent, those with a persistent (US) National Institutes of Health Stroke Scale (NIHSS) score of more than eight were treated with hypothermia to approximately 32 degrees Celsius for 12 to 72 hours, depending on vessel patency.
All were monitored in neurocritical care for complications and, at 90 days, a modified Rankin Scale was measured and compared with concurrent controls.
Ten patients averaging in their early 70s and with an NIHSS score of approximately 19.8 were treated with hypothermia; nine patients were concurrent controls.
Non-critical complications in hypothermia patients included bradycardia (five patients) ventricular ectopy (three), hypotension (three), melena (two), fever after rewarming (three) and infections (four).
Four patients with chronic atrial fibrillations developed rapid ventricular rate, which was non-critical in two and critical in two.
Three had myocardial infarctions without sequelae, and there were three deaths in hypothermia patients.
Mean modified Rankin Scale score at three months in hypothermia patients was approximately 3.1.
Stroke. 2001;32:1847.
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