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Determinants of Effective Cooling During Endovascular Hypothermia

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Abstract

Background

Therapeutic hypothermia is a promising neuroprotective therapy with multiple mechanisms of action. We demonstrated the feasibility of thrombolysis combined with endovascular hypothermia, but not all patients achieved effective cooling. We sought to identify the factors that determined effective cooling.

Methods

In 26 patients who underwent endovascular hypothermia, we computed four measures of effective cooling: time to reach target; Area-Under-the-Curve (AUC) 34 ratio; AUC-34; and AUC-35. By multivariate regression, we examined the effects of age, weight, starting temperature, body mass index, body surface area (BSA), gender, shivering, and total meperidine dose on the four outcome measures.

Results

In univariate analyses, all four outcome measures were significantly influenced by BSA (p < 0.01 in all univariate analyses). Time to reach target temperature was quicker in older patients (p < 0.01). Shivering and meperidine dose were highly intercorrelated (r = 0.6, p < 0.01) and both marginally influenced all four outcome measures. In multivariate analysis, AUC ratio and time to reach target temperature were significantly influenced by BSA (p < 0.01) and meperidine (p < 0.05); AUC-34 was influenced only by BSA (p < 0.01). The AUC-35 was influenced by BSA (p < 0.01), shivering, and total meperidine dose (p < 0.05).

Conclusions

The most important determinant of effective cooling during endovascular hypothermia is BSA; larger patients are more difficult to cool and maintain in therapeutic range. Older patients cool more quickly. Shivering was well controlled by the combination of meperidine, buspirone, and surface counter-warming and only minimally influenced cooling effectiveness. Future trials of therapeutic hypothermia may include added measures to cool larger patients more effectively.

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Acknowledgments

This study was supported by the National Institutes of Neurological Disorders and Health P50 NS044148 (Lyden).

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Authors and Affiliations

  1. Department of Neurology, Cedars-Sinai Medical Center, Thalians E240, 8730 Alden Drive, Los Angeles, CA, 90048, USA

    Patrick Lyden

  2. Department of Neurosciences, University of California, San Diego, CA, USA

    Patrick Lyden, Karen Rapp, Rema Raman & Thomas Hemmen

  3. Division of Biostatistics and Bioinformatics, Department of Family and Preventive Medicine, University of California, San Diego, CA, USA

    Karin Ernstrom & Rema Raman

  4. Department of Neurology, St. Louis University Medical Center, St. Louis, MO, USA

    Salvador Cruz-Flores

  5. Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Joao Gomes

  6. Department of Neurology, UTHealth Medical School, Houston, TX, USA

    James Grotta

  7. Innercool/Phillips, Inc., San Diego, CA, USA

    Anthony Mullin

  8. Department of Neurology and Neurological Sciences, Stanford Neurocritical Care Program, Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA, USA

    Christine Wijman

Authors
  1. Patrick Lyden
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  2. Karin Ernstrom
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  3. Salvador Cruz-Flores
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  4. Joao Gomes
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  7. Karen Rapp
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  8. Rema Raman
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  9. Christine Wijman
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  10. Thomas Hemmen
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Correspondence to Patrick Lyden.

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Lyden, P., Ernstrom, K., Cruz-Flores, S. et al. Determinants of Effective Cooling During Endovascular Hypothermia. Neurocrit Care 16, 413–420 (2012). https://doi.org/10.1007/s12028-012-9688-y

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  • DOI: https://doi.org/10.1007/s12028-012-9688-y

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