Prolonged moderate hypothermia in massive hemispheric infarction: clinical experience

Area of Science:

• Neurology
• Critical Care Medicine
• Neurocritical Care

Background:

• Malignant cerebral infarction (MaCI) carries a high mortality rate (around 80%) with severe disability in survivors.
• Conventional treatments like mechanical ventilation, mannitol, or barbiturates have limited efficacy.
• Moderate hypothermia (48-72 hours) shows promise but is often insufficient to manage persistent cerebral edema.

Purpose of the Study:

• To evaluate the efficacy and outcomes of prolonged moderate hypothermia in treating patients with MaCI.
• To assess the safety and side effects associated with this extended therapeutic approach.

Main Methods:

• A case series of twelve MaCI patients (27-64 years) treated with prolonged moderate hypothermia (32-33°C) for 11-22 days.
• Cooling was induced within 24 hours of infarction onset, maintained until CT showed reduced mass effect, followed by slow rewarming (2-5 days).
• Patients received mechanical ventilation and sedation with gamma-hydroxybutyrate (GHB).

Main Results:

• Seven out of twelve patients survived for 6 months, with six achieving independent ambulation.
• Five patients died due to cerebral herniation or infarct progression.
• Observed side effects included systemic hypotension, thrombocytopenia, and hyperfibrinogenemia in all patients.

Conclusions:

• Prolonged moderate hypothermia combined with gamma-hydroxybutyrate sedation offers a viable treatment strategy for MaCI.
• This approach can lead to improved clinical outcomes for survivors of malignant cerebral infarction.