Intensive Care Medicine

, 35:890

Intravascular cooling for rapid induction of moderate hypothermia in severely head-injured patients: results of a multicenter study (IntraCool)

Authors

    • Department of Neurosurgery, Vall d’Hebron University HospitalUniversitat Autonoma de Barcelona (UAB)
  • Jon Pérez-Bárcena
    • Intensive Care UnitSon Dureta University Hospital
    • Universitat Autonoma de Barcelona (UAB)
  • Alberto Biestro
    • Intensive Care Unit, Hospital de Clínicas
  • Elizabeth Zavala
    • Surgical ICU, Department of AnesthesiologyClinic University Hospital
  • Mari-Angels Merino
    • Neurotraumatology Research Unit, Vall d’Hebron University HospitalUniversitat Autonoma de Barcelona (UAB)
  • Anna Vilalta
    • Neurotraumatology Research Unit, Vall d’Hebron University HospitalUniversitat Autonoma de Barcelona (UAB)
  • Maria Antonia Poca
    • Department of Neurosurgery, Vall d’Hebron University HospitalUniversitat Autonoma de Barcelona (UAB)
  • Angel Garnacho
    • Neurotraumatology ICU, Vall d’Hebron University HospitalUniversitat Autonoma de Barcelona (UAB)
  • Ramon Adalia
    • Surgical ICU, Department of AnesthesiologyClinic University Hospital
  • Javier Homar
    • Intensive Care UnitSon Dureta University Hospital
  • Juan Antonio LLompart-Pou
    • Intensive Care UnitSon Dureta University Hospital
Original

DOI: 10.1007/s00134-008-1357-4

Cite this article as:
Sahuquillo, J., Pérez-Bárcena, J., Biestro, A. et al. Intensive Care Med (2009) 35: 890. doi:10.1007/s00134-008-1357-4

Abstract

Objectives

To evaluate the feasibility, safety and effectiveness of a new method of intravascular temperature management for inducing moderate hypothermia (MHT).

Design and settings

Prospective, international-multicenter clinical trial conducted in four university hospitals.

Patients

In a 2-year period 24 patients with severe head injury and refractory high ICP were treated with MHT (32.5°C) by intravascular methods.

Results

Seventeen were males and seven females, with a median age of 25 years (range 15–60). The median Glasgow Coma Scale upon admission was 7 (range 3–13) and the median Injury Severity Score was 22 (range 13–43). A total of 75% of patients presented a diffuse lesion in the pre-enrollment computed tomography. Median time from injury until reaching refractory high ICP was 71.5 h after injury (minimum 14 h, maximum 251 h). Twelve patients (50%) reached this situation within the first 72 h after injury. MHT was attained in a median time of 3 h. Pre-enrollment median ICP was 23.8 mmHg and was reduced to 16.8 mmHg upon reaching target temperature. At 6 months after injury, nine patients had died (37.5%), six were severely disabled (25%), two moderately disabled (8.3%) and seven had a good recovery (29.2%). Of the nine patients who died, in four the cause was rebound ICP during rewarming, one death was attributed to accidental potassium overload, two to septic shock, one to cardiac arrest of unknown origin and the ninth to a pulmonary embolism.

Conclusion

Intravascular methods to induce MHT combined with precooling with cold saline at 4°C appear to be feasible and effective in reducing ICP in patients with high ICP refractory to first-line therapeutic measures.

Keywords

Intravascular temperature managementModerate hypothermiaPilot studyRefractory high ICPSevere head injuryTraumatic brain injury

Supplementary material

134_2008_1357_MOESM1_ESM.doc (28 kb)
Supplementary material (DOC 28 kb)

Copyright information

© Springer-Verlag 2008