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Meta-Analysis
. 2009 Jan 21;2009(1):CD001247.
doi: 10.1002/14651858.CD001247.pub2.

Cooling therapy for acute stroke

Heleen M Den Hertog  1 , H Bart van der Worp, Mei-Chiun Tseng, Diederik Wj Dippel
Affiliations
Meta-Analysis

Cooling therapy for acute stroke

Heleen M Den Hertog et al. Cochrane Database Syst Rev. .

Abstract

Background: Increased body temperatures are common in patients with acute stroke and are associated with poor outcome. In animal models of focal cerebral ischaemia, temperature-lowering therapy reduces infarct volume. In patients with acute stroke, lowering temperature may therefore improve outcome. This is an update of a Cochrane review first published in 1999.

Objectives: To assess the effects of pharmacological and physical strategies to reduce body or brain temperature in patients with acute stroke.

Search strategy: We searched the Cochrane Stroke Group trials register (last searched December 2007). In addition, we searched MEDLINE and EMBASE (January 1998 to December 2007). We scanned references and contacted authors of included trials. For the previous version of this review, the authors contacted pharmaceutical companies and manufactures of cooling equipment in this field.

Selection criteria: We considered all completed randomised or non-randomised controlled clinical trials, published or unpublished, where pharmacological or physical strategies or both to reduce temperature were applied in patients with acute ischaemic stroke or intracerebral haemorrhage. Outcome measures were death or dependency (modified Rankin Scale score >/= 3) at the end of follow up, and adverse effects.

Data collection and analysis: Two review authors independently applied the inclusion criteria, assessed trial quality, and extracted and cross-checked the data.

Main results: We included five pharmacological temperature reduction trials and three physical cooling trials involving a total of 423 participants. We found no statistically significant effect of pharmacological or physical temperature-lowering therapy in reducing the risk of death or dependency (odds ratio (OR) 0.9, 95% confidence interval (CI) 0.6 to 1.4) or death (OR 0.9, 95% CI 0.5 to 1.5). Both interventions were associated with a non-significant increase in the occurrence of infections.

Authors' conclusions: There is currently no evidence from randomised trials to support routine use of physical or pharmacological strategies to reduce temperature in patients with acute stroke. Large randomised clinical trials are needed to study the effect of such strategies.

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Conflict of interest statement

Heleen M den Hertog is the study co‐ordinator of the ongoing PAIS trial. Dr Diederik WJ Dippel and Dr H Bart van der Worp were principal investigators of the PAPAS and PISA trials included in this review and of the ongoing PAIS trial. All the analyses and the interpretations reflect the opinions of the authors. No commercial organisation or other party was involved in the analysis or interpretation of data or in writing this review.

Figures

1.1
1.1. Analysis
Comparison 1 Temperature reduction versus control, Outcome 1 Death or dependency mRS ≥ 3.
1.2
1.2. Analysis
Comparison 1 Temperature reduction versus control, Outcome 2 Death.
2.1
2.1. Analysis
Comparison 2 Number of infections, Outcome 1 Number of infections.
3.1
3.1. Analysis
Comparison 3 Physical temperature reduction randomised vs controlled, Outcome 1 Death or dependency mRS ≥ 3.
3.2
3.2. Analysis
Comparison 3 Physical temperature reduction randomised vs controlled, Outcome 2 Death.
4.1
4.1. Analysis
Comparison 4 Pharmacological temperature reduction, Outcome 1 Temperature degree Celcius 24 hours.
5.1
5.1. Analysis
Comparison 5 Pharmacological cooling by duration of therapy, Outcome 1 Death or dependency.
5.2
5.2. Analysis
Comparison 5 Pharmacological cooling by duration of therapy, Outcome 2 Death.
6.1
6.1. Analysis
Comparison 6 Pharmacological cooling by type of treatment, Outcome 1 Death or dependency mRS ≥ 3.
6.2
6.2. Analysis
Comparison 6 Pharmacological cooling by type of treatment, Outcome 2 Death.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to ongoing studies

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