Therapeutic Hypothermia in Patients with Malignant Ischemic Stroke and Hemicraniectomy-A Systematic Review and Meta-analysis.

Craniotomy / methods Humans Hypothermia, Induced / methods Ischemic Stroke / diagnosis Multicenter Studies as Topic / methods Randomized Controlled Trials as Topic / methods
Decompressive hemicraniectomy Ischemic stroke Malignant stroke Meta-analysis Therapeutic hypothermia

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
09 2020
Historique:
received: 01 05 2020
revised: 28 05 2020
accepted: 30 05 2020
pubmed: 23 6 2020
medline: 7 1 2021
entrez: 23 6 2020
Statut: ppublish

Résumé

Therapeutic hypothermia (TH) offers cerebral protection following ischemic stroke and may improve outcomes in conjunction with decompressive hemicraniectomy (DHC). We aimed to assess the effectiveness of TH in patients with malignant ischemic stroke and DHC. We performed a meta-analysis in patients with malignant ischemic stroke undergoing DHC comparing TH versus normothermia in studies published up to August 2019. Included studies had ≥10 adults with acute ischemic stroke. Primary outcome was functional independence, and secondary outcomes included complications. Effect size was pooled and described by relative risk (RR) ratios and 95% confidence intervals (CIs). Five studies (n = 269 patients; n = 130 TH, n = 139 controls) were included, 4 of which were prospective (n = 2 randomized controlled trials). Median achieved body temperature of TH was 33.6°C (range 33°C-35°C). Median modified Rankin Scale at the study completion was similar between TH and controls (RR 1.08, 95% CI 0.56-2.07, P = 0.8). Three studies reported individual patient modified Rankin Scale outcomes demonstrated a shift toward worse outcomes with TH (unadjusted common odds ratio 1.74; 95% CI 1.05-2.88, P = 0.01). Overall complications were similar between groups (RR 1.20, 95% CI 0.70-2.05, random effects P = 0.5). A suggestion of higher mortality was seen in TH (RR 1.50, 95% CI 0.97-2.32, P = 0.07). Clinical and functional outcomes were not overall different between patients undergoing systemic TH and controls following DHC despite the shift toward worse outcomes with TH observed in some studies.

Sections du résumé

BACKGROUND
Therapeutic hypothermia (TH) offers cerebral protection following ischemic stroke and may improve outcomes in conjunction with decompressive hemicraniectomy (DHC). We aimed to assess the effectiveness of TH in patients with malignant ischemic stroke and DHC.
METHODS
We performed a meta-analysis in patients with malignant ischemic stroke undergoing DHC comparing TH versus normothermia in studies published up to August 2019. Included studies had ≥10 adults with acute ischemic stroke. Primary outcome was functional independence, and secondary outcomes included complications. Effect size was pooled and described by relative risk (RR) ratios and 95% confidence intervals (CIs).
RESULTS
Five studies (n = 269 patients; n = 130 TH, n = 139 controls) were included, 4 of which were prospective (n = 2 randomized controlled trials). Median achieved body temperature of TH was 33.6°C (range 33°C-35°C). Median modified Rankin Scale at the study completion was similar between TH and controls (RR 1.08, 95% CI 0.56-2.07, P = 0.8). Three studies reported individual patient modified Rankin Scale outcomes demonstrated a shift toward worse outcomes with TH (unadjusted common odds ratio 1.74; 95% CI 1.05-2.88, P = 0.01). Overall complications were similar between groups (RR 1.20, 95% CI 0.70-2.05, random effects P = 0.5). A suggestion of higher mortality was seen in TH (RR 1.50, 95% CI 0.97-2.32, P = 0.07).
CONCLUSIONS
Clinical and functional outcomes were not overall different between patients undergoing systemic TH and controls following DHC despite the shift toward worse outcomes with TH observed in some studies.

Identifiants

DOI: 10.1016/j.wneu.2020.05.277 PMID: 32569760
pubmed: 32569760
pii: S1878-8750(20)31256-0
doi: 10.1016/j.wneu.2020.05.277
pii:
doi:

Types de publication

Journal Article Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

e677-e685

Informations de copyright

Copyright © 2020 Elsevier Inc. All rights reserved.

Auteurs

Andrea M Kuczynski (AM)

Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Johanna M Ospel (JM)

Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Radiology Department, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland.

Andrew M Demchuk (AM)

Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Radiology Department, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Calgary, Alberta, Canada.

Mayank Goyal (M)

Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Radiology Department, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Calgary, Alberta, Canada.

Alim P Mitha (AP)

Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Radiology Department, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Calgary, Alberta, Canada.

Mohammed A Almekhlafi (MA)

Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Radiology Department, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Calgary, Alberta, Canada. Electronic address: mohammed.almekhlafi1@ucalgary.ca.

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Classifications MeSH

questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de neurochirurgie › Craniotomie › Therapeutic Hypothermia in Patients with...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Therapeutic Hypothermia in Patients with...
questionsmedicales.fr › Thérapeutique › Cryothérapie › Hypothermie provoquée › Therapeutic Hypothermia in Patients with...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Accident vasculaire cérébral ischémique › Therapeutic Hypothermia in Patients with...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études multicentriques comme sujet › Therapeutic Hypothermia in Patients with...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Therapeutic Hypothermia in Patients with...