Neurocritical Care

, Volume 16, Issue 3, pp 413–420 | Cite as

Determinants of Effective Cooling During Endovascular Hypothermia

  • Patrick Lyden
  • Karin Ernstrom
  • Salvador Cruz-Flores
  • Joao Gomes
  • James Grotta
  • Anthony Mullin
  • Karen Rapp
  • Rema Raman
  • Christine Wijman
  • Thomas Hemmen
Original Article

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.

Keywords

Stroke Clinical trial Hypothermia 

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Patrick Lyden
    • 1
    • 2
  • Karin Ernstrom
    • 3
  • Salvador Cruz-Flores
    • 4
  • Joao Gomes
    • 5
  • James Grotta
    • 6
  • Anthony Mullin
    • 7
  • Karen Rapp
    • 2
  • Rema Raman
    • 2
    • 3
  • Christine Wijman
    • 8
  • Thomas Hemmen
    • 2
  1. 1.Department of NeurologyCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of NeurosciencesUniversity of CaliforniaSan DiegoUSA
  3. 3.Division of Biostatistics and Bioinformatics, Department of Family and Preventive MedicineUniversity of CaliforniaSan DiegoUSA
  4. 4.Department of NeurologySt. Louis University Medical CenterSt. LouisUSA
  5. 5.Cerebrovascular Center, Neurological InstituteCleveland Clinic FoundationClevelandUSA
  6. 6.Department of NeurologyUTHealth Medical SchoolHoustonUSA
  7. 7.Innercool/Phillips, Inc.San DiegoUSA
  8. 8.Department of Neurology and Neurological Sciences, Stanford Neurocritical Care Program, Stanford Stroke CenterStanford University Medical CenterPalo AltoUSA

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