Targeted Temperature Management for Patients with Acute Ischemic Stroke: A Literature Review
Abstract
:1. Introduction
2. Methods
3. Results
3.1. Study Characteristics
3.1.1. Distribution of Study Designs
3.1.2. Time to TTM Initiation
3.1.3. Depth of TTM
First Author | Year | Study Design | Sample Size | Additional Therapy | Mean Age (Years) | Target Temperature (°C) | Time to TTM Initiation (Hours) | Time to Target Temperature (Hours) | Duration of TTM (Hours) | Method of Cooling | Site of Temperature Probe | Mechanism of Strokes |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Schwab [23] | 1998 | Prospective non- randomized | 25 | N/A | 49.0 | 33.0 | 14.0 ± 7.0 | 3.5–6.2 | 48.0–72.0 | Surface cooling (Polar Bair) with cool ventilator air | Bladder | MCA ischemic stroke |
Kammersgaard [33] | 2000 | Case–control | 73 (17 TTM cases) | N/A | 68.6 | N/A | <12.0 (mean 3.25) | 6.0 | 6.0 | Surface cooling (Polar Bair) with cool ventilator air | Tympanic Rectal | Combined ischemic/hemorrhagic |
Krieger [34] | 2001 | Case–control | 19 (10 TTM cases) | N/A | 71.1 | 32.0 | <6.0 | 3.5 ± 1.5 | 22.8 ± 8.0 | Surface cooling (Aquamatic K-Thermia EC600 blanket) + alcohol/ice bath | Bladder | MCA ischemic stroke |
Schwab [21] | 2001 | RCT | 50 | N/A | 57.0 ± 8.0 | 32.0–33.0 | 22.0 ± 9.0 | 3.5–11.0 | 24.0–72.0 | Surface cooling | N/A | Cardioembolism (n = 34) ICA dissection with secondary MCA embolization (n = 8) Atherothrombotic disease at the carotid bifurcation (n = 3) Unknown (n = 5) |
Georgiadis [32] | 2001 | Prospective non- randomized | 6 | Thrombolysis (n = 2) | 64.5 ± 8.4 | 33.0 | 28.2 ± 17.0 | 3.0 ± 1.0 | 67.0 ± 13.0 | Endovascular and selective head cooling | Bladder | Acute ischemic stroke |
Georgiadis [25] | 2002 | Prospective non- randomized | 19 | Hemicraniectomy | 56.0 | 33.0 | 24.0 | 4.0 ± 1.0 | 48.0–72.0 | Endovascular OR cold blanket + fan | Thermistor on endovascular catheter | MCA ischemic stroke |
Berger [36] | 2002 | Prospective observational study | 12 | Antiedema therapy with mannitol | N/A | 33.0 | <16.3 | N/A | 48.0–72.0 | Systemic surface | N/A | Space-occupying MCA infarction |
De Georgia [13] | 2004 | RCT | 40 (18 TTM cases) | N/A | 60.9 | 33.0 | <12.0 | 1.3 ± 0.7 | 24.0 | Endovascular (reprieve endovascular temperature management system) | Esophageal | Anterior circulation territory ischemic stroke |
Abou-Chebl [8] | 2004 | Prospective non- randomized | 18 | Various | 69.6 | 32.0 ± 1.0 | <8.0 | 3.2 ± 1.5 | 12.0–72.0 | Surface cooling (Aquamatic K-Thermia EC600 blanket) + alcohol/ice bath | Bladder | MCA ischemic stroke |
Lyden [26] | 2005 | Prospective non- randomized | 18 | N/A | 66.2 | 33.0 | <12.0 (mean 3.3) | 7.0 | 12.0 or 24.0 | Endovascular (Celsius Control catheter) | Tympanic Bladder Esophageal (2 out of 3) | Acute ischemic stroke |
Els [16] | 2006 | RCT | 25 (12 TTM cases) | Hemicraniectomy | 49.0 | 35.0 | Immediately after hemicraniectomy | 2.0 ± 1.0 | 48.0 | Intravenous saline (Icy, Cool Gard Perfusion Set) Surface cooling (thermo-wrap) | Tympanic Esophageal | Supratentorial ischemic stroke |
Guluma [27] | 2006 | Prospective non- randomized | 10 | IV thrombolysis | N/A | 33.0 | <6.0 | 1.7 ± 0.7 | 24.0 | Endovascular (Celsius Control catheter) | Thermistor on endovascular catheter | N/A |
Guluma [28] | 2008 | Prospective non- randomized | 18 | IV thrombolysis | 64.0 | 33.0 | <12.0 | 7.7 ± 4.1 | 12.0 or 24.0 | Endovascular (Celsius Control catheter) | Thermistor on endovascular catheter | Acute ischemic stroke |
Martin-Schild [22] | 2009 | Prospective non- randomized | 20 (18 TTM cases) | IV thrombolysis (n = 13) Caffeinol (n = 18) | 56.0 | 33.0–34.5 | 5.0 | 1.0 (n = 2) 2.0 (n = 4) 3.0 (n = 8) 4 did not reach target | 19.8 | Endovascular cooling Surface cooling | Bladder | Acute ischemic stroke |
Hemmen [11] | 2010 | RCT | 59 (28 TTM cases) | IV thrombolysis | 65.5 | 33.0 | <6.0 | Stratified 0.0–3.0 3.0–6.0 | 24.0 | Endovascular (Celsius Control Catheter) | Thermistor on endovascular catheter | Acute ischemic stroke |
Bi [10] | 2011 | RCT | 93 (31 TTM cases) | IV thrombolysis | Group A: 68.5 ± 6.9 | 32.0–34.0 | <6.0 | 0.3 | 24.0 | Surface Cooling | Rectal | Acute ischemic stroke |
Hong [35] | 2014 | Prospective cohort study | 75 (39 TTM cases) | IV thrombolysis | 64.5 ± 17.0 | 34.4 ± 0.9 | N/A | 6.3 ± 5.9 | 48.0 | Endovascular Surface cooling | Esophageal | Acute ischemic stroke involving the anterior circulation |
Ovesen [15] | 2013 | RCT | 31 (17 TTM cases) | IV thrombolysis | 62.3 | 33.0 | <24.0 | 14.9 | 24.0 | Endovascular Surface cooling | Bladder | Acute ischemic stroke |
Piironen [14] | 2014 | RCT | 36 (18 TTM cases) | IV thrombolysis | 68.0 | 35.0 | <6.0 | 6.0 (4.5–6.5) | 12.0 | Intravenous Saline, then maintained by surface cooling | Bladder | Acute ischemic stroke |
Lyden [17] | 2016 | RCT | 120 (63 TTM cases) | IV thrombolysis | 65.5 ± 10.3 | 33.0 | <6.0 | 4.8 ± 1.1 | 24.0 | Endovascular (Celsius Control Catheter) | N/A | Acute ischemic stroke |
Geurts [20] | 2017 | RCT | 22 (16 TTM cases) | N/A | 63.0 | 34.0 34.5 35.0 | <4.5 | 6.8 (34.5 °C) 7.4 (35.0 °C) | 24.0 | Intravenous saline + surface cooling | N/A | Acute ischemic stroke |
van der Worp [9] | 2019 | RCT | 98 (49 TTM cases) | N/A | 69.6 | 34.0–35.0 | <6.0 | N/A | 12.0 or 24.0 | IV saline Surface cooling | Rectal Bladder | N/A |
Neugebauer [12] | 2019 | RCT | 50 (26 TTM cases) | Hemicraniectomy | 51.3 (excluded over 60) | 33.0 ± 1.0 | <60.0 | N/A | 72.0 | Endovascular Surface cooling | Bladder | MCA |
Bardutzky [24] | 2023 | Prospective non- randomized | 22 | Various | 77.0 | 35.0 | After admission: 1.0 (0.7–1.3) After EVT-dependent intubation: 0.08 (0.06–0.09) Prior to groin puncture: 0.09 (0.03–0.17) | 0.5 (0.4–0.6) | 6.0 (post-recanalization) | Transnasal (RhinoChill) | Esophageal Tympanic | Occlusion of the M1 or M2 segment of the MCA or ICA or tandem occlusion; ischemic stroke |
First Author | Year of Publication | Study Design | Sample Size | Additional Therapy | Mean Age (Years) | Target Temperature (°C) | Time to TTM Initiation (Hours) | Time to Target Temperature (Minutes) | Duration of TTM (Minutes) | Method of Cooling | Site of Temperature Probe | Mechanism of Strokes |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Kollmar [29] | 2009 | Prospective non- randomized | 10 | IV thrombolysis | 66.5 ± 12.5 | N/A | <3.0 | N/A | 240.0 | Intra-arterial Selective cooling infusion | Tympanic | Acute ischemic stroke |
Chen [30] | 2016 | Prospective non- randomized | 26 | Recanalization (various) | 58.4 | N/A | <8.0 | 5.0 (pre-stent) | 10.0 (post-stent) | Intra-arterial Selective cooling infusion | Rectal | Proximal vessel (ICA, MCA M1 + M2, BA/VA) ischemic stroke |
Peng [18] | 2016 | RCT | 26 (11 TTM cases) | IV thrombolysis | N/A | N/A | <6.0 | N/A | 10.0 | Intra-arterial Selective cooling infusion | N/A | MCA |
Wu [31] | 2018 | Prospective non- randomized | 113 (45 TTM cases) | Mechanical thrombectomy | 62.1 | N/A | <6.0 | N/A | 15.0 | Intra-arterial Selective cooling infusion | N/A | M1 segment of the MCA |
Wan [19] | 2023 | RCT | 142 (71 TTM cases) | Mechanical thrombectomy | 73.4 | N/A | <24.0 | N/A | 35.0 | Intra-arterial Selective cooling infusion | N/A | M1 and M2 segments of the ICA and MCA, including the extracranial and intracranial segments |
Normothermic | Hypothermic | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Stroke | Health Outcomes | Stroke | Health Outcomes | ||||||||||||
First Author | Year | Severity (NIHSS) | Functionally Independent (%) | Infarct Volume (mL) | Mortality (%) | Pneumonia (%) | Edema Formation (%) | Hemorrhage (%) | Severity (NIHSS) | Functionally Independent (%) | Infarct Volume (mL) | Mortality (%) | Pneumonia (%) | Edema Formation (%) | Hemorrhage (%) |
Schwab [23] | 1998 | N/A | N/A | N/A | 78.0 | N/A | N/A | N/A | 4 weeks: 29.0 (25.0–37.0) 3 months: 38.0 (28.0–48.0) | N/A | N/A | 44.0 | 40.0 | N/A | N/A |
Kammersgaard [33] | 2000 | 6 months: 47.9 ± 11.4 | N/A | N/A | 28 days: 11.0 6 months: 23.0 | 13.0 | N/A | N/A | 6 months: 42.4 ± 13.7 | N/A | N/A | 28 days: 6.0 6 months: 12.0 | 18.0 | N/A | N/A |
Krieger [34] | 2001 | Baseline: 19.6 ± 2.6 | 3 months: 11.1 | N/A | 3 months: 22.2 | 11.1 | N/A | N/A | Baseline: 19.8 ± 3.3 | 3 months: 50.0 | N/A | 3 months: 30.0 | 30.0 | N/A | N/A |
Schwab [21] | 2001 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | Baseline: 25.0 (15.0–32.0) 4 weeks: 29.0 | N/A | N/A | 38.0 | 48.0 | N/A | N/A |
Georgiadis [32] | 2001 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 16.7 | 100.0 | N/A | N/A |
Georgiadis [25] | 2002 | Baseline: 17.0 (16.0–18.0) | N/A | N/A | 18 months: 12.0 | N/A | N/A | N/A | Baseline: 20.0 (18.0–22.0) | N/A | N/A | 18 months: 47.0 | 18 months: 78.9 | N/A | N/A |
Berger [36] | 2002 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 33.3 | N/A | N/A | N/A |
De Georgia [13] | 2004 | Baseline: 14.6 ± 5.6 Baseline corrected: 16.7 ± 4.4 | N/A | N/A | 10 | 5.0 | 2.5 | N/A | Baseline: 15.2 ± 4.4 Baseline corrected: 18.2 ± 4.4 | N/A | Infarct volume growth was less in the hypothermia group but not significant | 12.5 | 5.0 | 7.5 | 2.5 |
Abou-Chebl [8] | 2004 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | Baseline: 21.4 ± 5.6 | N/A | N/A | 11.1 | 27.8 | N/A | 5.6 |
Lyden [26] | 2005 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 16.7 | 30 days: 5.6 | N/A | 16.7 |
Els [16] | 2006 | Baseline: 19.0 ± 2.0 6 months: 10.0 ± 1.0 | N/A | N/A | 15.0 | N/A | N/A | N/A | Baseline: 18.0 ± 2.0 6 months: 11.0 ± 3.0 | N/A | N/A | 8.0 | N/A | N/A | N/A |
Guluma [27] | 2006 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 0.0 | 0.0 | 0.0 | 0.0 |
Guluma [28] | 2008 | Immediately following catheter removal: 12.3 ± 8.5 30 days: 9.1 ± 7.8 | N/A | 30 days: 73.0 ± 71.0 | N/A | N/A | N/A | N/A | Immediately following catheter removal: 13.3 ± 11.0 30 days: 14.4 ± 14.3 | 30 days: no difference in modified Rankin scores | 30 days: 84.0 ± 102.0 | N/A | N/A | Significantly decreased | N/A |
Martin-Schild [22] | 2009 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | Baseline: 15.0 24 h: 9.0 Discharge/5 days: 6.0 | Discharge: 40.0 | N/A | Hospitalization: 15.0 | 20.0 | 1.0 | 20.0 |
Hemmen [11] | 2010 | Baseline: 13.7 ± 5.1 24 h: 11.1 ± 8.1 1 month: 5.0 ± 4.1 3 months: 3.8 ± 3.0 | 90 days: 24.0 | N/A | 90 days: 16.7 | 10.0 | N/A | 48 h: 25.0 | Baseline: 14.3 ± 5.0 24 h: 17.0 ± 8.9 1 month: 8.0 ± 6.5 3 months: 6.3 ± 6.6 | 90 days: 18.0 | N/A | 90 days: 21.4 | 50.0 | N/A | 48 h: 33.0 |
Bi [10] | 2011 | Thrombolysis baseline: 11.0 ± 2.7 Thrombolysis 90 days: −4.1 ± 0.5 Anti-platelet baseline: 10.8 ± 2.7 Anti-platelet 90 days: −1.5 ± 0.4 | 90 days: thrombolysis 39.3 anti-platelet 13.8 | N/A | 90 days: thrombolysis 9.7 anti-platelet 6.5 | N/A | N/A | 24 h: thrombolysis symptomatic 3.2 thrombolysis Asymptomatic 19.4 Anti-platelet symptomatic 0.0 Anti-platelet asymptomatic 6.5 | Baseline: 11.4 ± 2.8 90 days: −4.0 ± 0.6 | 90 days: 48.1 | N/A | 90 days: 12.9 | N/A | N/A | 24 h: symptomatic 6.5 asymptomatic 16.1 |
Hong [35] | 2014 | Baseline: 15.5 (12.0–17.0) | 90 days: 22.2 | N/A | 1 month: 13.9 | 30.6 | 83.3 | 86.1 | Baseline: 17.0 (15.0–18.0) | 90 days: 48.7 | N/A | 1 month: 15.4 | 5.1 | 46.2 | 61.5 |
Ovesen [15] | 2013 | Baseline: 9.0 48 h: 6.0 7 days: 6.0 90 days: 4.0 | N/A | N/A | 9.0 | 9.0 | N/A | 14.3 | Baseline: 8.0 48 h: 15.0 7 days: 11.0 90 days: 4.0 | N/A | N/A | 12.0 | 35.0 | N/A | 5.9 |
Piironen [14] | 2014 | Baseline: 14.0 | 3 months: 39.0 | N/A | N/A | 3 days: 11.0 | 3 days: 44.0 | 3 days: 28.0 | Baseline: 11.0 | 3 months: 39.0 | N/A | 0.0 | 3 days: 39.0 | 3 days: 28.0 | 3 days: 33.0 |
Lyden [17] | 2016 | Baseline: 14.5 ± 4.9 7 days: 10.6 ± 11.3 | 90 days: 38.0 | N/A | 8.8 | 10.5 | N/A | 3.5 | Baseline: 14.1 ± 4.8 7 days: 10.4 ± 10.3 | 90 days: 33.0 | N/A | 15.9 | 19.0 | N/A | 1.6 |
Geurts [20] | 2017 | Baseline: 13.0 3 months: 4.0 | 3 months: 50.0 | N/A | 3 months: 17.0 | 0.0 | N/A | 0.0 | Baseline: 13.0 3 months: 8.0 | 3 months: 37.0 | N/A | 3 months: 12.0 | 53.0 | N/A | 13.3 |
van der Worp [9] | 2019 | Baseline: 11.0 (7.0–17.0) 3 months: 3.0 (1.0–11.0) | 3 months: 39.0 | N/A | 3 months: 8.2 | 4.1 | 2.0 | 4.1 | Baseline: 11.0 (7.0–17.0) 3 months: 3.0 (1.0–8.0) | 3 months: 50.0 | 34.3 (10.5–65.5) | 3 months: 10.2 | 18.4 | 8.2 | 8.2 |
Neugebauer [12] | 2019 | Baseline: 20.5 (15.0–42.0) 14 days: 22.0 (16.0–33.0) | 12 months: 4.0 | N/A | 14 days: 12.5 12 months: 13.0 | 63.0 | N/A | N/A | Baseline: 21.0 (15.0–42.0) 14 days: 25.0 (17.0–37.0) | 12 months: 0.0 | N/A | 14 days: 19.2 12 months: 24.0 | 54.0 | N/A | N/A |
Bardutzky [24] | 2023 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | Baseline: 15.0 (12.5–19.8) 24 h: 7.0 (3.0–12.5) 7 days: 2.0 (1.0–8.0) | Discharge: 64.0 3 months: 68.0 | N/A | 3 months: 9.0 | 18.0 | N/A | 18.0 |
Normothermic | Hypothermic | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Stroke | Health Outcomes | Stroke | Health Outcomes | ||||||||||||
First Author | Year | Severity (NIHSS) | Functionally Independent (%) | Infarct Volume (mL) | Mortality (%) | Pneumonia (%) | Edema Formation (%) | Hemorrhage (%) | Severity (NIHSS) | Functionally Independent (%) | Infarct Volume (mL) | Mortality (%) | Pneumonia (%) | Edema Formation (%) | Hemorrhage (%) |
Kollmar [29] | 2009 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | Baseline: 5.5 (4.0–12.0) 24 h: 3.0 (1.0–13.0) | N/A | N/A | N/A | N/A | N/A | N/A |
Chen [30] | 2016 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 38.5 | N/A | 0.0 |
Peng [18] | 2016 | Baseline: 16.8 ± 8.2 24 h: 12.3 ± 5.5 1 month: 9.2 ± 3.4 | N/A | Baseline: 25.0 ± 10.1 24 h: 25.6 ± 10.2 7 days: 26.4 ± 10.9 | N/A | N/A | N/A | N/A | Baseline: 16.3 ± 8.5 24 h: 10.0 ± 6.9 1 month: 7.1 ± 5.1 | N/A | Baseline: 24.9 ± 9.4 24 h: 13.5 ± 6.0 7 days: 12.3 ± 7.4 | N/A | N/A | N/A | N/A |
Wu [31] | 2018 | Baseline: 16.0 (11.0–19.0) | 90 days: 41.2 | 3–7 days: 77.9 ± 44.7 | 90 days: 26.5 | 7 days or discharge: 33.8 | N/A | 7 days or discharge: 32.4 | Baseline: 17.0 (13.0–21.0) | 90 days: 51.1 | 3–7 days: 63.7 ± 31.8 | 90 days: 20.0 | 7 days or discharge: 31.1 | N/A | 7 days or discharge: 35.6 |
Wan [19] | 2023 | Baseline: 16.0 ± 8.0 14 days: 3.5 ± 2.1 | 90 days: 35.2 | 7 days: 88.5 ± 20.8 | 90 days: 8.5 | 7 days: 21.1 | N/A | 24 h: 15.5 | Baseline: 15.0 ± 7.0 14 days: 2.0 ± 1.2 | 90 days: 54.9 | 7 days: 63.7 ± 22.1 | 90 days: 7.0 | 7 days: 23.9 | N/A | 24 h: 18.3 |
3.1.4. Duration of TTM
3.1.5. Fibrinolytic Therapies
3.2. Outcomes
3.2.1. Mortality Rates
3.2.2. NIHSS Severity Changes
3.2.3. Functional Outcomes
3.2.4. Pneumonia Rates
3.2.5. Hemorrhage Rates
4. Discussion
4.1. Mechanism of TTM for Stroke Management
4.2. Time to Cooling Initiation and Target Temperature
4.3. Method of Cooling
4.4. Degree of Hypothermia
4.5. Duration of Cooling
4.6. Fibrinolytic Therapies
4.7. Comorbidities
4.8. Outcomes
4.9. Recommendations for TTM in Stroke Patients
4.10. Limitations and Future Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Binda, D.D.; Baker, M.B.; Varghese, S.; Wang, J.; Badenes, R.; Bilotta, F.; Nozari, A. Targeted Temperature Management for Patients with Acute Ischemic Stroke: A Literature Review. J. Clin. Med. 2024, 13, 586. https://doi.org/10.3390/jcm13020586
Binda DD, Baker MB, Varghese S, Wang J, Badenes R, Bilotta F, Nozari A. Targeted Temperature Management for Patients with Acute Ischemic Stroke: A Literature Review. Journal of Clinical Medicine. 2024; 13(2):586. https://doi.org/10.3390/jcm13020586
Chicago/Turabian StyleBinda, Dhanesh D., Maxwell B. Baker, Shama Varghese, Jennifer Wang, Rafael Badenes, Federico Bilotta, and Ala Nozari. 2024. "Targeted Temperature Management for Patients with Acute Ischemic Stroke: A Literature Review" Journal of Clinical Medicine 13, no. 2: 586. https://doi.org/10.3390/jcm13020586