Targeted Temperature Management for Poor Grade Aneurysmal Subarachnoid Hemorrhage: A Pilot Study

Area of Science:

• Neurology
• Critical Care Medicine
• Neurosurgery

Background:

• Aneurysmal subarachnoid hemorrhage (aSAH) is a critical condition often leading to poor neurological outcomes.
• Target temperature management (TTM) is a therapeutic strategy explored for its potential benefits in neurocritical care.

Purpose of the Study:

• To evaluate the effectiveness and safety of TTM in patients with poor-grade aSAH.
• To assess the neurological outcome at 3 months post-treatment.
• To analyze secondary outcomes including mortality, delayed cerebral ischemia, and cerebral edema.

Main Methods:

• A single-blind, nonrandomized controlled trial included 60 patients with poor-grade aSAH (Hunt-Hess scores IV-V).
• Patients were assigned 1:1 to either a TTM group or a control group.
• TTM involved initial cooling to 36°C-37°C, followed by induction to 33°C-35°C for 3-5 days, and then slow rewarming.

Main Results:

• A favorable prognosis (modified Rankin scale 0-3) at 3 months was significantly higher in the TTM group (46.7%) compared to the control group (20.0%, P=0.028).
• Multivariate analysis indicated that TTM significantly reduced the odds of an unfavorable prognosis (OR=0.20, P=0.019).

Conclusions:

• TTM is effective and safe for treating patients with poor-grade aSAH.
• Implementation of TTM improved neurological outcomes in this patient cohort.
• Further multicenter randomized controlled studies are warranted to validate these findings.