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Infusion warm during selective hypothermia in acute ischemic stroke
Thomas L Merrill1,2, Bradley F Smith1, Jennifer E Mitchell2
1Department of Mechanical and Biomedical Engineering, Rowan University, Glassboro, USA.
Brain Circulation
|January 18, 2020
Summary
Selective hypothermia for acute ischemic stroke (AIS) patients shows significant warming along the catheter pathway, limiting cooling effectiveness. Coaxial catheter designs offer a modest temperature benefit, achieving only a 1°C drop in brain tissue temperature.
Area of Science:
- Neurology
- Biomedical Engineering
- Therapeutic Hypothermia
Background:
- Mechanical thrombectomy improves outcomes for acute ischemic stroke (AIS) patients.
- However, suboptimal neurological outcomes persist in up to half of AIS patients post-thrombectomy.
- Therapeutic hypothermia is a promising neuroprotective strategy with strong preclinical support.
Purpose of the Study:
- To investigate warming effects that diminish selective hypothermia's effectiveness in AIS.
- To evaluate different catheter configurations and infusion parameters on cooling potency.
- To simulate conditions relevant to clinical practice.
Main Methods:
- Four selective hypothermia layouts were tested, varying catheter number and use of insulated IV bags.
- Infusion parameters included flow rates from 8-25 ml/min over 20 minutes.
- Key measurements: IV bag exit, catheter inlet, and outlet temperatures.
Main Results:
- Warming predominantly occurred along the catheter pathway (66-72%) rather than the infusion line.
- Coaxial configurations yielded a ~4°C cooler infusate compared to single catheters.
- Maximum cooling achieved was a 1°C drop in predicted brain tissue temperature within 5 minutes.
Conclusions:
- Significant rewarming occurs during infusate transport to the brain in selective hypothermia.
- Clinical studies using similar parameters likely achieved only rapid, shallow brain cooling (~1°C).
- Optimizing infusate delivery is crucial for effective therapeutic hypothermia in AIS.
