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. 2019 Sep;4(3):254-262.
doi: 10.1177/2396987319844690. Epub 2019 Apr 20.

Therapeutic hypothermia for acute ischaemic stroke. Results of a European multicentre, randomised, phase III clinical trial

H Bart van der Worp  1 , Malcolm R Macleod  2 , Philip Mw Bath  3 , Raj Bathula  4 , Hanne Christensen  5 , Bridget Colam  2 , Charlotte Cordonnier  6 , Jacques Demotes-Mainard  7 , Isabelle Durand-Zaleski  8 , Christian Gluud  9 , Janus Christian Jakobsen  9   10 , Bernd Kallmünzer  11 , Rainer Kollmar  12 , Derk W Krieger  13 , Kennedy R Lees  14 , Dominik Michalski  15 , Carlos Molina  16 , Joan Montaner  17 , Risto O Roine  18 , Jesper Petersson  19 , Richard Perry  20 , Nikola Sprigg  3 , Dimitre Staykov  11   21 , Istvan Szabo  22 , Geert Vanhooren  23 , Joanna M Wardlaw  24 , Per Winkel  9 , Stefan Schwab  11 ; EuroHYP-1 investigators
Affiliations

Therapeutic hypothermia for acute ischaemic stroke. Results of a European multicentre, randomised, phase III clinical trial

H Bart van der Worp et al. Eur Stroke J. 2019 Sep.

Abstract

Introduction: We assessed whether modest systemic cooling started within 6 hours of symptom onset improves functional outcome at three months in awake patients with acute ischaemic stroke.

Patients and methods: In this European randomised open-label clinical trial with blinded outcome assessment, adult patients with acute ischaemic stroke were randomised to cooling to a target body temperature of 34.0-35.0°C, started within 6 h after stroke onset and maintained for 12 or 24 h , versus standard treatment. The primary outcome was the score on the modified Rankin Scale at 91 days, as analysed with ordinal logistic regression.

Results: The trial was stopped after inclusion of 98 of the originally intended 1500 patients because of slow recruitment and cessation of funding. Forty-nine patients were randomised to hypothermia versus 49 to standard treatment. Four patients were lost to follow-up. Of patients randomised to hypothermia, 15 (31%) achieved the predefined cooling targets. The primary outcome did not differ between the groups (odds ratio for good outcome, 1.01; 95% confidence interval, 0.48-2.13; p = 0.97). The number of patients with one or more serious adverse events did not differ between groups (relative risk, 1.22; 95% confidence interval, 0.65-1.94; p = 0.52).

Discussion: In this trial, cooling to a target of 34.0-35.0°C and maintaining this for 12 or 24 h was not feasible in the majority of patients. The final sample was underpowered to detect clinically relevant differences in outcomes.

Conclusion: Before new trials are launched, the feasibility of cooling needs to be improved.

Keywords: Ischaemic stroke; cooling; hypothermia; randomised trial; treatment.

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Figures

Figure 1.
Figure 1.
Flow of patients through the study.
Figure 2.
Figure 2.
Body temperatures in the first 12 h after start of treatment in the overall trial population.
Figure 3.
Figure 3.
Distribution of scores on the modified Rankin Scale at 91 days.
See this image and copyright information in PMC

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