Targeted Temperature Management for Severe Subarachnoid Hemorrhage Using Endovascular and Surface Cooling Systems: A...

Area of Science:

• Neurology
• Critical Care Medicine
• Neurosurgery

Background:

• Severe subarachnoid hemorrhage (SAH) poses significant risks, with rebound fever after targeted temperature management (TTM) linked to poor outcomes.
• Effective fever control is crucial in managing SAH patients to mitigate secondary brain injury.

Purpose of the Study:

• To evaluate the efficacy of endovascular TTM following rewarming from initial surface cooling in severe SAH patients.
• To assess the impact of prolonged TTM on preventing delayed cerebral ischemia and improving patient outcomes.

Main Methods:

• A comparative study of 72 patients with World Federation of Neurological Surgeons grade V SAH, divided into a control group (antipyretics) and a study group (endovascular TTM).
• Both groups received initial surface TTM at 34°C post-SAH diagnosis and emergency aneurysm repair.
• The study group underwent 7-day endovascular TTM at 36-38°C after rewarming, while the control group received standard antipyretic treatment.

Main Results:

• The endovascular TTM group showed a significantly lower incidence and duration of fever (>38°C) compared to the control group (13 vs. 26 patients, P = .0021).
• Incidence of vasospasm-related cerebral infarction was reduced in the endovascular TTM group (17% vs. 42%, P = .037).
• Excellent outcomes (modified Rankin Scale 0-1) at 6 months were more frequent in the endovascular TTM group (42% vs. 17%, P = .037).

Conclusions:

• Endovascular TTM at 36-38°C after initial surface cooling is a feasible and safe adjunctive therapy for severe SAH.
• This combined 2-week TTM strategy is associated with reduced vasospasm-related infarction and improved neurological outcomes in severe SAH patients.