Therapeutic Hypothermia in Acute Ischemic Stroke-a Systematic Review and Meta-Analysis

Purpose of Review Therapeutic hypothermia (TH) in stroke demonstrates robust neuroprotection in animals but clinical applications remain controversial. We assessed current literature on the efficacy of TH in ischemic stroke. Recent Findings We conducted a meta-analysis comparing TH versus controls in studies published until June 2019. Controlled studies reporting on >= 10 adults with acute ischemic stroke were included. Primary outcome was functional independence (modified Rankin Scale [mRS] <= 2). Twelve studies (n = 351 TH, n = 427 controls) were included. Functional independence did not differ between groups (RR 1.17, 95% CI 0.93-1.46, random-effects p = 0.2). Five studies reported individual mRS outcomes and demonstrated a shift toward better outcome with TH (unadjusted cOR 1.57, 95% CI 1.01-2.44, p = 0.05). Overall complications were higher with TH (RR 1.18, 95% CI 1.06-1.32, p < 0.01). We did not observe an overall beneficial effect of TH in this analysis although some studies showed a shift toward better outcome. TH was associated with increased complications.