Consensus recommendations on therapeutic hypothermia after minimally invasive intracerebral hemorrhage evacuation from the hypothermia for intracerebral hemorrhage (HICH) working group

被引：6

作者：

Baker, Turner S. ^{[1
,2
]}

Kellner, Christopher P. ^{[2
]}

Colbourne, Frederick ^{[3
]}

Rincon, Fred ^{[4
]}

Kollmar, Rainer ^{[5
,6
]}

Badjatia, Neeraj ^{[7
]}

Dangayach, Neha ^{[2
]}

Mocco, J. ^{[2
]}

Selim, Magdy H. ^{[8
]}

Lyden, Patrick ^{[9
]}

Polderman, Kees ^{[10
]}

Mayer, Stephan ^{[11
,12
,13
]}

机构：

[1] Icahn Sch Med Mt Sinai, Sinai BioDesign, New York, NY 10029 USA

[2] Icahn Sch Med Mt Sinai, Dept Neurosurg, New York, NY 10029 USA

[3] Univ Alberta, Dept Psychol, Edmonton, AB, Canada

[4] Thomas Jefferson Univ, Thomas Jefferson Univ Hosp, Dept Neurol, Philadelphia, PA USA

[5] Friedrich Alexander Univ Erlangen Nurnberg FAU, Univ Hosp Erlangen, Dept Neurol, Erlangen, Germany

[6] Darmstadt Acad Teaching Hosp, Dept Neurol & Neurol Intens Care, Darmstadt, Germany

[7] Univ Maryland, Dept Neurol, Sch Med, Baltimore, MD USA

[8] Harvard Univ, Beth Israel Deaconess Med Ctr, Dept Neurol, Boston, MA USA

[9] Univ Southern Calif, Zilkha Neurogenet Inst, Keck Sch Med, Dept Physiol & Neurosci, Los Angeles, CA USA

[10] United Mem Med Ctr, Houston, TX USA

[11] Westchester Med Ctr Hlth Network, Valhalla, NY USA

[12] New York Med Coll, Dept Neurol, Valhalla, NY USA

[13] New York Med Coll, Dept Neurosurg, Valhalla, NY USA

来源：

FRONTIERS IN NEUROLOGY | 2022年 / 13卷

关键词：

therapeutic hypothermia; targeted temperature management; intracerebral hemorrhage; intracranial pressure; perihematomal edema; minimally invasive surgery recommendations for focal hypothermia in ICH; TARGETED TEMPERATURE MANAGEMENT; CARDIAC-ARREST; INTRACRANIAL HYPERTENSION; PREREPERFUSION INFUSION; PERIHEMORRHAGIC EDEMA; PLASMINOGEN-ACTIVATOR; ISCHEMIC TERRITORY; BRAIN; STROKE; MECHANISMS;

D O I：

10.3389/fneur.2022.859894

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and purposeTherapeutic hypothermia (TH), or targeted temperature management (TTM), is a classic treatment option for reducing inflammation and potentially other destructive processes across a wide range of pathologies, and has been successfully used in numerous disease states. The ability for TH to improve neurological outcomes seems promising for inflammatory injuries but has yet to demonstrate clinical benefit in the intracerebral hemorrhage (ICH) patient population. Minimally invasive ICH evacuation also presents a promising option for ICH treatment with strong preclinical data but has yet to demonstrate functional improvement in large randomized trials. The biochemical mechanisms of action of ICH evacuation and TH appear to be synergistic, and thus combining hematoma evacuation with cooling therapy could provide synergistic benefits. The purpose of this working group was to develop consensus recommendations on optimal clinical trial design and outcomes for the use of therapeutic hypothermia in ICH in conjunction with minimally invasive ICH evacuation. MethodsAn international panel of experts on the intersection of critical-care TH and ICH was convened to analyze available evidence and form a consensus on critical elements of a focal cooling protocol and clinical trial design. Three focused sessions and three full-group meetings were held virtually from December 2020 to February 2021. Each meeting focused on a specific subtopic, allowing for guided, open discussion. ResultsThese recommendations detail key elements of a clinical cooling protocol and an outline for the roll-out of clinical trials to test and validate the use of TH in conjunction with hematoma evacuation as well as late-stage protocols to improve the cooling approach. The combined use of systemic normothermia and localized moderate (33.5 degrees C) hypothermia was identified as the most promising treatment strategy. ConclusionsThese recommendations provide a general outline for the use of TH after minimally invasive ICH evacuation. More research is needed to further refine the use and combination of these promising treatment paradigms for this patient population.

引用

页数：9

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