Volume 26, Issue 1 (Avicenna Journal of Clinical Medicine-Spring 2019)                   Avicenna J Clin Med 2019, 26(1): 26-33 | Back to browse issues page

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Rozbahani A, Rezaee M, Khazaei M. Impact of Mild Hypothermia on the Recovery of Patients with Acute Stroke. Avicenna J Clin Med 2019; 26 (1) :26-33
URL: http://sjh.umsha.ac.ir/article-1-1864-en.html
1- , monir.rezaee@yahoo.co.uk
2- Assistant Professor, Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran
Abstract:   (3561 Views)
Background and Objective: Hypothermia induction has been proposed to improve the recovery process of stroke in the last two decades. Therefore, the aim of this study was to investigate the effect of mild hypothermia on the recovery of patients with acute stroke.
Materials and Methods: This single-blind randomized clinical trial was conducted on 60 patients with acute stroke in 2018 in Hamadan, Iran. The patients were selected by available sampling method, and then randomly assigned into two equal-sized groups of intervention and control. Mild hypothermia was induced using a cooling device applied on the patients' head for a period of 72 h. The National Institutes of Health Stroke Scale (NIHSS) was used to collect the data. The results of both groups were compared with each other following the intervention. Finally, the data were analyzed using SPSS software (version 22).
Results: The results showed no significant difference between the mean scores obtained before and after the intervention in the control group (P>0.05). In addition, there was no significant difference between the intervention and control groups in terms of the pre-intervention mean scores (P>0.05). However, the results revealed a statistically significant difference in the mean pre- and post-intervention scores of the intervention group (P<0.05). In this regard, the mean score of NIHSS was significantly reduced in the intervention group after the induction of hypothermia. Finally, the results were indicative of a statistically significant difference between the intervention and control groups after the intervention (P<0.05).
Conclusion: As the findings of the present study indicated, noninvasively induced hypothermia has a significant clinical effect on acute stroke. Therefore, it can be argued that the use of hypothermia leads to the enhancement of consciousness level and reduction of mortality risk in patients with acute stroke. Consequently, this intervention is suggested to be considered the main therapeutic approach of acute stroke.
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Type of Study: Original | Subject: Neurology

1. Goetz CG. Textbook of clinical neurology. New York: Elsevier Health Sciences; 2007.
2. Malani PN. Harrison’s principles of internal medicine. JAMA. 2012;308(17):1813-4. DOI:10.1001/jama.308.17.1813-b
3. Daneshfard B, Izadi S, Shariat A, Toudaji MA, Beyzavi Z, Niknam L. Epidemiology of stroke in Shiraz, Iran. Iran J Neurol. 2015;14(3):158-63. PMID: 26622981
4. Tran J, Mirzaei M, Anderson L, Leeder SR. The epidemiology of stroke in the Middle East and North Africa. J Neurol Sci. 2010;295(1-2):38-40. PMID: 20541222 DOI: 10.1016/j.jns.2010.05.016
5. Kim JS. Stroke in Asia: a global disaster. Int J Stroke. 2014;9(7):856-7. PMID: 25231579 DOI: 10.1111/ijs.12317
6. Mehndiratta MM, Khan M, Mehndiratta P, Wasay M. Stroke in Asia: geographical variations and temporal trends. J Neurol Neurosurg Psychiatry. 2014;85(12):1308-12. PMID: 24769474 DOI: 10.1136/jnnp-2013-306992
7. Ghandehari K. Epidemiology of stroke in Iran. Galen Med J. 2016;5(S1):3-9.
8. Caplan LR. Caplan's stroke. Cambridge: Cambridge University Press; 2016.
9. Bradley WG. Neurology in clinical practice: principles of diagnosis and management: Didcot, UK: Taylor & Francis; 2004.
10. Oliveira V, Kumutha JR, Narayanan E, Somanna J, Benkappa N, Bandya P, et al. Hypothermia for encephalopathy in low-income and middle-income countries: feasibility of whole-body cooling using a low-cost servo-controlled device. BMJ Paediatr Open. 2018;2(1):e000245. PMID: 29637198 DOI: 10.1136/bmjpo-2017-000245
11. Takeda Y, Kawashima T, Kiyota K, Oda S, Morimoto N, Kobata H, et al. Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room. Resuscitation. 2014;85(12):1647-53. PMID: 25263513 DOI: 10.1016/j.resuscitation.2014.09.014
12. Bergan HA, Halvorsen PS, Skulstad H, Fosse E, Bugge JF. Does therapeutic hypothermia during extracorporeal cardiopulmonary resuscitation preserve cardiac function? J Transl Med. 2016;14(1):345. PMID: 27998282 DOI: 10.1186/s12967-016-1099-y
13. Chandrasekaran PN, Dezfulian C, Polderman KH. What is the right temperature to cool post-cardiac arrest patients? Crit Care. 2015;19(1):406. PMID: 26577919 DOI: 10.1186/s13054-015-1134-z
14. Kan P, Duckworth E, Germanwala AV, Pelargos P, Cho JM, Choy W, et al. Neurosurgery concepts: Key perspectives on embolectomy for stroke with emergent large vessel occlusion (MR CLEAN), endonasal endoscopic craniopharyngioma resection, gamma knife radiosurgery for meningiomas, therapeutic hypothermia for severe traumatic brain injury. Surg Neurol Int. 2015;6:165. PMID: 26962466 DOI: 10.4103/2152-7806.168064
15. Andresen M, Gazmuri JT, Marín A, Regueira T, Rovegno M. Therapeutic hypothermia for acute brain injuries. Scand J Trauma Resusc Emerg Med. 2015;23(1):42. PMID: 26043908 DOI: 10.1186/s13049-015-0121-3
16. Han Z, Liu X, Luo Y, Ji X. Therapeutic hypothermia for stroke: where to go? Exp Neurol. 2015;272:67-77. PMID: 26057949 DOI: 10.1016/j.expneurol.2015.06.006
17. Szczygielski J, Müller A, Mautes AE, Sippl C, Glameanu C, Schwerdtfeger K, et al. Selective brain hypothermia mitigates brain damage and improves neurological outcome after post-traumatic decompressive craniectomy in mice. J Neurotrauma. 2017;34(8):1623-35. PMID: 27799012 DOI: 10.1089/neu.2016.4615
18. Basiri B, Eghbalian F, Vakili GK. Evolution of the therapeutic effects of induced local hypothermia in neonates with hypoxic-ischemic encephalopathy. Avicenna J Clin Med. 2011;18(1):5-9.
19. Ehsani V, Allahtavakoli M, Dashti M, Rezvani M, Rezazadeh H, Shamsizadeh A, et al. Effect of general hypothermia on the embolic model of stroke in the male rat. J Shaheed Sadoughi Univ Med Sci. 2014;21(6):776-83.
20. Kasner SE, Chalela JA, Luciano JM, Cucchiara BL, Raps EC, McGarvey ML, et al. Reliability and validity of estimating the NIH stroke scale score from medical records. Stroke. 1999;30(8):1534-7. PMID: 10436096
21. Hinkle JL. Reliability and validity of the National Institutes of Health Stroke Scale for neuroscience nurses. Stroke. 2014;45(3):e32-4. PMID: 24496393 DOI: 10.1161/STROKEAHA.113.004243
22. Kazemnejad LE, Rezaei S, Hosseininezhad M, Bakhshayesh EB, Saberi A, Keshavarz P. The applicability, concurrent validity and internal consistency reliability of the persian version of the national institutes of health stroke scale (NIHSS): evidences for gender differences. Caspian J Neurol Sci. 2016;2(4):18-28.
23. Kurisu K, Yenari MA. Therapeutic hypothermia for ischemic stroke; pathophysiology and future promise. Neuropharma-cology. 2018;134:302-9 PMID: 28830757 DOI: 10.1016/j.neuropharm.2017.08.025
24. Jeong HY, Chang JY, Yum KS, Hong JH, Jeong JH, Yeo MJ, et al. Extended use of hypothermia in elderly patients with malignant cerebral edema as an alternative to hemicraniectomy. J Stroke. 2016;18(3):337-43. PMID: 27488978 DOI: 10.5853/jos.2016.00276
25. Hutchison JS, Ward RE, Lacroix J, Hébert PC, Barnes MA, Bohn DJ, et al. Hypothermia therapy after traumatic brain injury in children. N Engl J Med. 2008;358(23):2447-56. PMID: 18525042 DOI: 10.1056/NEJMoa0706930
26. Bayegan K, Janata A, Frossard M, Holzer M, Sterz F, Losert UM, et al. Rapid non-invasive external cooling to induce mild therapeutic hypothermia in adult human-sized swine. Resuscitation. 2008;76(2):291-8. PMID: 17764806 DOI: 10.1016/j.resuscitation.2007.07.006
27. Krieger DW, Yenari MA. Therapeutic hypothermia for acute ischemic stroke: what do laboratory studies teach us? Stroke. 2004;35(6):1482-9. PMID: 15073396 DOI: 10.1161/01.STR.0000126118.44249.5c
28. Schultheiss M, Schnichels S, Hermann T, Hurst J, Feldkaemper M, Arango-Gonzalez B, et al. Hypothermia protects and prolongs the tolerance time of retinal ganglion cells against ischemia. PLoS One. 2016;11(2):e0148616. PMID: 26848953 DOI: 10.1371/journal.pone.0148616
29. Bi Y, Huan Y, Cai W, Wang X, Liang Z, Liu Z, et al. Mild hypothermia in combination with minimally invasive evacuation of hematoma reduces inflammatory damage in patients via the nuclear factor‑κB pathway. Exp Ther Med. 2014;8(6):1717-22. DOI: 10.3892/etm.2014.2012
30. Alzaga AG, Cerdan M, Varon J. Therapeutic hypothermia. Resuscitation. 2006;70(3):369-80. PMID: 16930801 DOI: 10.1016/j.resuscitation.2006.01.017
31. Nogueira AB, Nogueira AB, Esteves Veiga JC, Teixeira MJ. Multimodality monitoring, inflammation, and neurore-generation in subarachnoid hemorrhage. Neurosurg. 2014;75(6):678-89. PMID: 25050583 DOI: 10.1227/NEU.0000000000000512
32. Dénes Á, Ferenczi S, Kovács KJ. Systemic inflammatory challenges compromise survival after experimental stroke via augmenting brain inflammation, blood-brain barrier damage and brain oedema independently of infarct size. J Neuroinflammation. 2011;8(1):164. PMID: 22114895 DOI: 10.1186/1742-2094-8-164
33. Schock RB, Janata A, Peacock F, Deal NS, Kalra S, Fritz S. Time to cooling is associated with resuscitation outcomes. Ther Hypothermia Temp Manag. 2016;6(4):208-17. PMID: 27906641 DOI: 10.1089/ther.2016.0026
34. Macleod MR, Petersson J, Norrving B, Hacke W, Dirnagl U, Wagner M, et al. Hypothermia for stroke: call to action 2010. Int J Stroke. 2010;5(6):489-92. PMID: 21086713 DOI: 10.1111/j.1747-4949.2010.00520.x
35. Lyden PD, Allgren RL, Ng K, Akins P, Meyer B, Al-Sanani F, et al. Intravascular Cooling in the Treatment of Stroke (ICTuS): early clinical experience. J Stroke Cerebrovasc Dis. 2005;14(3):107-14. PMID: 17904009 DOI: 10.1016/j.jstrokecerebrovasdis.2005.01.001
36. Poli S, Purrucker J, Priglinger M, Ebner M, Sykora M, Diedler J, et al. Rapid Induction of COOLing in Stroke Patients (iCOOL1): a randomised pilot study comparing cold infusions with nasopharyngeal cooling. Crit Care. 2014;18(5):582. PMID: 25346332 DOI: 10.1186/s13054-014-0582-1
37. Tahir RA, Pabaney AH. Therapeutic hypothermia and ischemic stroke: a literature review. Surg Neurol Int. 2016;7(14):S381-6. PMID: 27313963 DOI: 10.4103/2152-7806.183492

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