Abstract
Background
Temperature management using endovascular catheters is an established therapy in neurointensive care. Nonetheless, several case series have reported a high rate of thrombosis related to the use of endovascular hypothermia catheters.
Methods
As a result of a pulmonary embolism that developed in a patient after removing an inferior vena cava hypothermia catheter, we designed a clinical protocol for managing and removing these devices. First, an invasive cavography was performed before the removal of the catheter. If there was a thrombus, a cava vein filter was inserted through jugular access. After that, the catheter was removed.
Results
The venography found inferior vena cava thrombi in 18 of 20 consecutive patients. A concomitant ultrasonography study showed vena cava thrombosis in only three patients. A vena cava filter was inserted in all patients where thrombi were found, without any significant complication. Anticoagulation was started in all patients. No symptomatic pulmonary embolism was diagnosed until the time of discharge.
Conclusions
The frequency of thrombosis related to temperature management catheters is extremely high (90 %). Furthermore, ultrasonography has a very low sensibility to detect cava vein thrombosis (16.7 %). The real meaning of our findings is unknown, but other temperature control systems could be a safer option. More studies are needed to confirm our findings.
Similar content being viewed by others
References
Badjatia N. Hyperthermia and fever control in brain injury. Crit Care Med. 2009;37(Suppl 7):S250–7.
Schreckinger M, Marion DW. Contemporary management of traumatic intracranial hypertension: is there a role for therapeutic hypothermia? Neurocrit Care. 2009;11:427–36.
Kollmar R, Staykov D, Dorfler A, Schellinger PD, Schwab S, Bardutzky J. Hypothermia reduces perihemorrhagic edema after intracerebral hemorrhage. Stroke. 2010;41:1684–9.
Torok E, Klopotowski M, Trabold R, Thal SC, Plesnila N, Scholler K. Mild hypothermia (33 degrees C) reduces intracranial hypertension and improves functional outcome after subarachnoid hemorrhage in rats. Neurosurgery. 2009;65:352–9; discussion 359.
Kollmar R, Schwab S. Hypothermia and ischemic stroke. Curr Treat Options Neurol. 2012;14:188–96.
Stravitz RT, Larsen FS. Therapeutic hypothermia for acute liver failure. Crit Care Med. 2009;37:S258–64.
Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Eng J Med. 2002;346:557–63.
Group HaCAS. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Eng J Med. 2002;346:549–56.
Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369:2197–206.
Badjatia N. Fever control in the neuro-ICU: why, who, and when? Curr Opin Crit Care. 2009;15:79–82.
Sulter G, Elting JW, Maurits N, Luijckx GJ, De Keyser J. Acetylsalicylic acid and acetaminophen to combat elevated body temperature in acute ischemic stroke. Cerebrovasc Dis. 2004;17:118–22.
Kasner SE, Wein T, Piriyawat P, Villar-Cordova CE, Chalela JA, Krieger DW, Morgenstern LB, Kimmel SE, Grotta JC. Acetaminophen for altering body temperature in acute stroke: a randomized clinical trial. Stroke. 2002;33:130–4.
Schwab S, Kollmar R. Rise of the machines: controlling the body temperature of critically ill patients by endovascular catheters. Neurocrit Care. 2004;1:127–30.
Polderman KH, Herold I. Therapeutic hypothermia and controlled normothermia in the intensive care unit: practical considerations, side effects, and cooling methods. Crit Care Med. 2009;37:1101–20.
Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, Rigaud JP, Casciani D, Misset B, Bosquet C, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001;286:700–7.
Lau E, Bajzer C, Menon V. Inferior vena cava thrombus associated with intravascular cooling catheter. Resuscitation. 2010;81:1457–8.
Prunet B, Lacroix G, Bordes J, Poyet R, D’Aranda E, Goutorbe P. Catheter related venous thrombosis with cooling and warming catheters: two case reports. Cases J. 2009;2:8857.
Retamal J, Bachler J, Mejia R, Concha O, Andresen M. Venous thrombosis secondary to catheter insertion for hypothermia after cardiac arrest. Report of one case. Rev Med Chil. 2011;139:1201–5.
Simosa HF, Petersen DJ, Agarwal SK, Burke PA, Hirsch EF. Increased risk of deep venous thrombosis with endovascular cooling in patients with traumatic head injury. Am Surg. 2007;73:461–4.
Taylor EE, Carroll JP, Lovitt MA, Petrey LB, Gray PE, Mastropieri CJ, Foreman ML. Active intravascular rewarming for hypothermia associated with traumatic injury: early experience with a new technique. Proc (Bayl Univ Med Cent). 2008;21:120–6.
Park JH, Lee JB, Han MC, Choi BI, Im CK, Yeon KM, Kim CW. Sonographic evaluation of inferior vena caval obstruction: correlative study with vena cavography. AJR Am J Roentgenol. 1985;145:757–62.
Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD, Kearon C, Schunemann HJ, Crowther M, Pauker SG, et al. Diagnosis of DVT: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141:e351S–418S.
Andrews RT. Contrast peripheral phlebography and pulmonary angiography for diagnosis of thromboembolism. Circulation. 2004;109(12 suppl 1):I22–7.
Knudson MM, Ikossi DG, Khaw L, Morabito D, Speetzen LS. Thromboembolism after trauma: an analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank. Ann Surg. 2004;240:490–6; discussion 496–498.
Gregory PC, Kuhlemeier KV. Prevalence of venous thromboembolism in acute hemorrhagic and thromboembolic stroke. Am J Phys Med Rehabil. 2003;82:364–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Reccius, A., Mercado, P., Vargas, P. et al. Inferior Vena Cava Thrombosis Related to Hypothermia Catheter: Report of 20 Consecutive Cases. Neurocrit Care 23, 72–77 (2015). https://doi.org/10.1007/s12028-014-0069-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12028-014-0069-6