Effect and feasibility of therapeutic hypothermia in patients with hemorrhagic stroke: a systematic review and meta-analysis.

Effect and feasibility of therapeutic hypothermia in patients with hemorrhagic stroke: a systematic review and meta-analysis.

World Neurosurg. 2018 Jan 08;:

Authors: Yao Z, You C, He M

Abstract
INTRODUCTION: Therapeutic hypothermia (TH) has shown a good performance in the experimental hemorrhagic stroke. But the clinical application of TH remains controversial since reports regarding its therapeutic effect are inconsistent.
METHODS: We conducted a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-analyses. Compare TH with control group in terms of mortality, the poor outcome, delayed cerebral ischemia (DCI) and specific complications. The subgroup analyses were stratified by study type, country, mean age, hemorrhage type, cooling method, treatment duration, rewarming velocity and follow-up time.
RESULTS: Nine studies were included, most of which were of moderate quality. The overall effect demonstrated insignificant differences in mortality (risk ratio [RR], 0.78; 95% confidence interval [CI], 0.58 1.06; p=0.11) and the poor outcome rate (RR, 0.89; 95%CI, 0.70 1.12; p=0.32) between TH and the control group. But the sensitivity analyses after omitting one study achieved statistically significant difference in the poor outcome favoring TH. Moreover, in the subgroup analyses, the result derived from randomized studies revealed TH significantly reduced poor outcomes (RR, 0.40; 95%CI, 0.22 0.74; p=0.003). Additionally, TH significantly reduced DCI compared with control (RR, 0.61; 95%CI, 0.40 0.93; p=0.02). The incidences of specific complications (rebleeding, pneumonia, sepsis, arrhythmia and hydrocephalus) between two groups were comparable and did not reach significant difference.
CONCLUSIONS: The overall effect showed TH did not significantly reduce the mortality and poor outcomes, but led to a decreased incidence of DCI. Compared with control, TH resulted in comparable incidences of specific complications.

PMID: 29325957 [PubMed - as supplied by publisher]

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