Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial
Abstract Background The effect of hypothermia on large hemispheric infarction (LHI) remains controversial. Our study aimed to explore the therapeutic outcomes of decompressive craniectomy (DC) combined with hypothermia on LHI. Methods Patients were randomly divided into three groups: the DC group, t...
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ftdoajarticles:oai:doaj.org/article:db2b9901c93748c498ee732a7689e3b0 2023-05-15T16:38:24+02:00 Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial Linlin Fan Yingying Su Yan Zhang Hong Ye Weibi Chen Gang Liu 2021-03-01T00:00:00Z https://doi.org/10.1186/s12883-021-02142-7 https://doaj.org/article/db2b9901c93748c498ee732a7689e3b0 EN eng BMC https://doi.org/10.1186/s12883-021-02142-7 https://doaj.org/toc/1471-2377 doi:10.1186/s12883-021-02142-7 1471-2377 https://doaj.org/article/db2b9901c93748c498ee732a7689e3b0 BMC Neurology, Vol 21, Iss 1, Pp 1-8 (2021) Large hemispheric infarction Decompressive craniectomy Target temperature management Randomized controlled trial Neurological outcome Neurology. Diseases of the nervous system RC346-429 article 2021 ftdoajarticles https://doi.org/10.1186/s12883-021-02142-7 2022-12-31T10:53:45Z Abstract Background The effect of hypothermia on large hemispheric infarction (LHI) remains controversial. Our study aimed to explore the therapeutic outcomes of decompressive craniectomy (DC) combined with hypothermia on LHI. Methods Patients were randomly divided into three groups: the DC group, the DC plus head surface cooling (DCSC) group and the DC plus endovascular hypothermia (DCEH) group. The DC group was maintained normothermia. The DCSC group received 24-h ice cap on the head for 7 days. While the DCEH group were given endovascular hypothermia (34 °C). Mortality and modified Rankin Scale (mRS) score at 6 months were evaluated. Results Thirty-four patients were included in the study. Mortality of the DC, DCSC and DCEH groups at discharge were 22.2% (2/9), 0% (0/14) and 9.1% (1/11), respectively. However, it increased to 44.4% (4/9), 21.4% (3/14) and 45.5% (5/11) at 6 months, respectively (p = 0.367). Pneumonia (8 cases) was the leading cause of death after discharge. Twelve cases (35.3%) achieved good neurological outcome (mRS 0–3) at 6 months. The proportions of good neurological outcome in the DC, DCSC and DCEH groups were 22.2% (2/9 cases), 42.9% (6/14 cases) and 36.4% (4/11), respectively. The DCSC group seemed to have higher proportion of good outcomes, but there was no significant difference between groups (p = 0.598). Among survivors, endovascular hypothermia had a higher proportion of good outcome (DC group, 2/5 cases, 40.0%; DCSC group, 6/11 cases, 54.5%; DCEH group, 4/6 cases, 66.7%; p = 0.696). The incidence of complications in the DCEH group was higher than those of the DC and DCSC groups (18.9%, 12.0%, and 12.1%, respectively; p = 0.025). Conclusions There is still no evidence to confirm that hypothermia further reduces long-term mortality and improves neurological outcomes in LHI patients with DC. However, there is a trend to benefit survivors from hypothermia. A local cooling method may be a better option for DC patients, which has little impact on systematic complications. Trial ... Article in Journal/Newspaper Ice cap Directory of Open Access Journals: DOAJ Articles BMC Neurology 21 1 |
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topic |
Large hemispheric infarction Decompressive craniectomy Target temperature management Randomized controlled trial Neurological outcome Neurology. Diseases of the nervous system RC346-429 |
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Large hemispheric infarction Decompressive craniectomy Target temperature management Randomized controlled trial Neurological outcome Neurology. Diseases of the nervous system RC346-429 Linlin Fan Yingying Su Yan Zhang Hong Ye Weibi Chen Gang Liu Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial |
topic_facet |
Large hemispheric infarction Decompressive craniectomy Target temperature management Randomized controlled trial Neurological outcome Neurology. Diseases of the nervous system RC346-429 |
description |
Abstract Background The effect of hypothermia on large hemispheric infarction (LHI) remains controversial. Our study aimed to explore the therapeutic outcomes of decompressive craniectomy (DC) combined with hypothermia on LHI. Methods Patients were randomly divided into three groups: the DC group, the DC plus head surface cooling (DCSC) group and the DC plus endovascular hypothermia (DCEH) group. The DC group was maintained normothermia. The DCSC group received 24-h ice cap on the head for 7 days. While the DCEH group were given endovascular hypothermia (34 °C). Mortality and modified Rankin Scale (mRS) score at 6 months were evaluated. Results Thirty-four patients were included in the study. Mortality of the DC, DCSC and DCEH groups at discharge were 22.2% (2/9), 0% (0/14) and 9.1% (1/11), respectively. However, it increased to 44.4% (4/9), 21.4% (3/14) and 45.5% (5/11) at 6 months, respectively (p = 0.367). Pneumonia (8 cases) was the leading cause of death after discharge. Twelve cases (35.3%) achieved good neurological outcome (mRS 0–3) at 6 months. The proportions of good neurological outcome in the DC, DCSC and DCEH groups were 22.2% (2/9 cases), 42.9% (6/14 cases) and 36.4% (4/11), respectively. The DCSC group seemed to have higher proportion of good outcomes, but there was no significant difference between groups (p = 0.598). Among survivors, endovascular hypothermia had a higher proportion of good outcome (DC group, 2/5 cases, 40.0%; DCSC group, 6/11 cases, 54.5%; DCEH group, 4/6 cases, 66.7%; p = 0.696). The incidence of complications in the DCEH group was higher than those of the DC and DCSC groups (18.9%, 12.0%, and 12.1%, respectively; p = 0.025). Conclusions There is still no evidence to confirm that hypothermia further reduces long-term mortality and improves neurological outcomes in LHI patients with DC. However, there is a trend to benefit survivors from hypothermia. A local cooling method may be a better option for DC patients, which has little impact on systematic complications. Trial ... |
format |
Article in Journal/Newspaper |
author |
Linlin Fan Yingying Su Yan Zhang Hong Ye Weibi Chen Gang Liu |
author_facet |
Linlin Fan Yingying Su Yan Zhang Hong Ye Weibi Chen Gang Liu |
author_sort |
Linlin Fan |
title |
Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial |
title_short |
Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial |
title_full |
Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial |
title_fullStr |
Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial |
title_full_unstemmed |
Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial |
title_sort |
decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial |
publisher |
BMC |
publishDate |
2021 |
url |
https://doi.org/10.1186/s12883-021-02142-7 https://doaj.org/article/db2b9901c93748c498ee732a7689e3b0 |
genre |
Ice cap |
genre_facet |
Ice cap |
op_source |
BMC Neurology, Vol 21, Iss 1, Pp 1-8 (2021) |
op_relation |
https://doi.org/10.1186/s12883-021-02142-7 https://doaj.org/toc/1471-2377 doi:10.1186/s12883-021-02142-7 1471-2377 https://doaj.org/article/db2b9901c93748c498ee732a7689e3b0 |
op_doi |
https://doi.org/10.1186/s12883-021-02142-7 |
container_title |
BMC Neurology |
container_volume |
21 |
container_issue |
1 |
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1766028666455719936 |