Artikel
Mild hypothermia by continuous intravenous cooling as an additional treatment option for patients with severe cerebral vasospasm after subarachnoid hemorrhage
Suche in Medline nach
Autoren
Veröffentlicht: | 8. Juni 2016 |
---|
Gliederung
Text
Objective: Cerebral vasospasm (CV) remains one of the leading causes for mortality and morbidity in patients suffering from subarachnoid hemorrhage. We established the use of continuous intra-arterial nimodipine infusion (CIAN) when HH-therapy is not sufficient to treat patients with severe CV. But even with this invasive treatment some patients still have ischemic values in multimodal neuromonitoring (MMN). For those patients hypotheria might be an additional treatment option.
Method: In patients with refractory vasospasm CIAN was initiated when HH therapy wasn’t sufficient to keep PbtO2 >15 mmHG. When PbtO2 values remained critical despite maximum nimodipine dosage and HH therapy, we tried mild hypothermia (35°C) using a continuous intravenous cooling device ( CoolGard®).
Results: Of 21 patients treated with CIAN 2 patients did not respond to therapy at all and died during hospital stay. 8 of the remaining patients showed PbtO2 <15 mmHG despite maximum nimodipine dosage of 1.2 mg/h. Thus we induced mild hypothermia (35°C) using the CoolGard® system via the subclavian vein. All patients reached target temperature within 65 min and median cooling-time was 94 h. PbtO2 levels stabilized in all patients. Rewarming was done in a controlled manner with 0.2 °C/h. No thrombotic complications and no infections due to the additional catheter in the subclavian vein were found. At 6 months after hospital discharge 6 patients had a GOS of 4 and 2 GOS 5.
Conclusions: Continuous intravenous cooling using the CoolGard® is a feasible technique to induce mild hypothermia. It allows a rapid and precise cool-down and temperature can be kept stable within a small range. Mild hypothermia led to significant improvement of PbtO2 levels in patients with severe CV in combination with a very low complication rate. Thus we believe continuous intravenous cooling is a useful treatment addition for patients with CV.