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Cooling therapy for acute stroke
1Neurology Department, Hospital Geral de Santo António, Largo Prof Abel Salazar, Porto, Portugal, 4050. nedcv@mail.telepac.pt
Insights
Current evidence does not support routine cooling therapy for acute stroke patients. Further randomized trials are needed to investigate the neuroprotective potential of hypothermia in stroke treatment.
Area of Science:
- Neurology
- Critical Care Medicine
Background:
- Emerging research links body temperature to prognosis in acute stroke patients.
- Fever management is a critical aspect of acute stroke care.
Purpose of the Study:
- To evaluate the efficacy of therapeutic cooling in patients experiencing acute ischemic stroke or primary intracerebral hemorrhage.
- To synthesize evidence from randomized controlled trials on cooling therapy for acute stroke.
Main Methods:
- Comprehensive literature search of multiple databases (Cochrane Stroke Group, MEDLINE, EMBASE) up to November 1998.
- Inclusion of completed randomized controlled trials and controlled clinical trials, regardless of publication status.
- Contacting trial investigators and manufacturers for additional data on cooling interventions.
Main Results:
- No randomized controlled trials (RCTs) or controlled clinical trials were identified that met the inclusion criteria.
- One placebo-controlled trial investigating the antipyretic drug metamizol is currently in progress.
Conclusions:
- There is insufficient evidence from RCTs to recommend routine use of physical or chemical cooling for acute stroke.
- Experimental data suggest potential neuroprotective effects of hypothermia in cerebral ischemia and improved outcomes in severe head injury.
- Further well-designed clinical trials are warranted to explore the role of cooling therapy in acute stroke management.
Background:
Recent studies in acute stroke patients have shown an association between body temperature and prognosis.
Objectives:
Our objective was to assess the effects of cooling when applied to patients with acute ischaemic stroke or primary intracerebral haemorrhage.
Search Strategy:
We searched the Cochrane Stroke Group's trial register (last searched in March 1999), plus MEDLINE searched up to November 1998 and EMBASE searched from January 1980 to November 1998. We contacted investigators, pharmaceutical companies and manufacturers of cooling equipment in this field.
Selection Criteria:
All completed randomised controlled trials or controlled clinical trials, published or unpublished, where cooling therapy (therapy given by physical devices or antipyretic drugs primarily to lower body temperature independently of basal temperature at the beginning of treatment) was applied up to two weeks of an acute ischaemic stroke or primary intracerebral haemorrhage.
Data Collection And Analysis:
Two reviewers independently searched for relevant trials.
Main Results:
No randomised trials or controlled trials were identified; one placebo-controlled trial of metamizol is currently underway.
Reviewer'S Conclusions:
There is currently no evidence from randomised trials to support the routine use of physical or chemical cooling therapy in acute stroke. Since experimental studies showed a neuroprotective effect of hypothermia in cerebral ischaemia, and hypothermia appears to improve the outcome in patients with severe closed head injury, trials with cooling therapy in acute stroke are warranted.